LiveLongAgeWell

It was a striking, almost metaphorical, image on TV today. The outgoing vice-president seemed disabled, in a wheelchair due to a back injury. The new president, young and vigorous. Best wishes to him! Our inauguration edition is dedicated to you, that you too keep your back young and healthy.

In my Friday post I discussed unnecessary tonsil surgeries from the view of a tonsillectomy patient as well as a surgeon. Today let’s consider back and spine operations. Many health care experts, and even a number of orthopedic surgeons, believe many people who undergo back operations would be better served without surgery; and being treated instead with more conservative measures such as physical therapy, or just patience.

Most back pain will go away on its own without any treatment at all. Fortunately, in many ways—maybe more often than you might imagine—the body heals itself. Sometimes, probably frequently, we muck up and complicate natural healing—causing more harm than good—with surgery. It’s a fine line, and a really good surgeon, who is first looking out for the needs of his or her patient, has the judgment to know when to cut and when to wait.

Particularly in some areas of medicine financial pressures can cloud the surgeon’s judgment, and we can use back surgery as an example. Medical device companies, huge profit machines, need orthopedic surgeons to use their products over the competition’s. These companies hire practicing doctors as “consultants” who can be paid tens or hundreds of thousands of dollars yearly to “help develop” and promote their particular brand. The patient is rarely aware of this arrangement.

The Wall Street Journal several days ago reported on a prominent spine surgeon and faculty member of the University of Wisconsin who earned 19 million dollars over five years from device maker Medtronic. This is an extreme example, but you might be interested to know that the medical device salespeople are OFTEN present in the operating room when an orthopedic surgeon operates, offering advice and assistance on using their products.

Here are a few interesting points about back and spine surgery:

• Back pain is the second most common pain complaint (headache being first), and is the number one cause of work-related disability.
• The number of spinal surgeries has surged over the past several decades; from the early 90s to the early 00s, back surgeries in the Medicare age group rose almost four times. It’s not clear that this surge in surgeries has resulted in more happy patients.
• The surgeries carry risks and not all patients’ symptoms are cured by surgery.  A study last year showed that in patients with sciatica (pain shooting down the leg), 95% were better after one year whether or not they had surgery (though those who had surgery tended to have pain relief more quickly, but the final result was the same).
• Even sophisticated X-rays can be misleading. An MRI can show one problem such as a herniated disc, but the patient’s symptoms might be coming from another problem not seen on the X-ray.
• Of course some back surgeries are necessary, and if you are ever faced with spine or back problems and surgery is considered, consider seeking out an opinion from a surgeon member of the Association For Ethics In Spine Surgery. This group is committed to eliminating the influence of the device manufacturers, and making surgical judgments based purely on the needs of the patient.