A condition known as spinal stenosis is one of the top reasons older Americans seek surgery for lower back pain, and the number of people afflicted with the disorder is expected to grow as the population ages. A recent study in the Journal of the American Medical Association (JAMA), as detailed in this Wall Street Journal article, looked at the situation.

Some orthopedic doctors are concerned the procedure has gotten more complicated than it needs to be as some surgeons combine traditional stenosis therapy with other procedures that fuse vertebrae. The more complex surgery can be beneficial for some patients, especially those with more than one spinal disorder. But it also raises the cost of treatment and increases the chances of complications, including stroke and death, recent research shows:

• The number of complex spinal surgeries has grown at a rapid rate:, now accounting for 19.9 per 100,000 surgeries from 1.3 per 100,000.
• Although patients suffering only stenosis and not other spinal conditions were less likely to receive the combined procedures, these patients still accounted for as many as 50% of the complex surgeries.
• The higher rate of complex procedures increased hospital costs for surgery by 40%.
• The complication rate of those cases also was higher at 5.6% compared to 2.3% for the simpler, decompression surgery.
• Hospitals stays were on average two days longer for complex surgery.
• Average per-patient hospital charges were $80,888, compared with $23,724 for the simpler surgery.

Why the rate of increase? An aging population is inherently going to mean an increase in the number of spine surgeries in general, as vertebra naturally degenerate over time. However, the rate of increase currently happening is far greater than that transition would call for.

“Many factors are at play, but I think the finances play an important part,” says Richard Deyo, a professor of evidence-based medicine at Oregon Health & Science University in Portland, Ore., and lead author of the JAMA study. “There are some prominent surgeons who have strong financial connections to device manufacturers.”

Christopher Bono, an orthopedic surgeon at Brigham and Women’s Hospital in Boston, says the JAMA article doesn’t explain why the surgery numbers are increasing other than “insinuating that it is because of marketing and surgeon greed.” He says there could be other reasons for the increase “such as better corrections of deformities.”

“It has not been shown that the more complex surgery is better [for patients with simple stenosis], but people are willing to have it done,” says Eugene J. Caragee, an orthopedic surgeon at Stanford University School of Medicine, who has written on the topic in medical journals. “The marketing is relentless,” he says. Read more…