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A study of Medicare patients shows that costlier, more complex spinal fusion surgeries are on the rise — and sometimes done unnecessarily — for a common lower back condition caused by aging and arthritis.

What’s more alarming is that the findings suggest these more challenging operations are riskier, leading to more complications and even deaths.

“This is exactly what the health care debate has been dancing around,” said Dr. Eugene Carragee of Stanford University Medical Center. “You have one kind of operation that could cost $20,000 and another that could cost $80,000, and there’s not good evidence the expensive one is being used appropriately in the majority of cases.”
Add to that the expense for patients with problems after surgery, and “that’s not a trivial amount of money” for Medicare, said Carragee. He wrote an editorial in the Journal of the American Medical Association, where the federally funded study appears today.

All the patients in the study had stenosis in their lower backs, a painful squeezing in the spine that’s most common in people over 50. The researchers compared the risks for three different, types of surgery for the condition: decompression, simple fusion and complex fusion.

“It s not necessarily true that the more aggressive surgery is better, at least in terms of safety,” said the lead author, Dr. Richard Deyo of Oregon Health and Science University in Portland.

Patients should ask their doctors about alternatives to complicated operations, Deyo said. Could steroid injections and physical therapy be tried? Would a simple decompression procedure be as helpful as a spinal fusion?

In a decompression procedure, the simplest method studied, a surgeon cuts away part of the bone that’s pressing on nerves. It can cost about $30,000 in hospital and surgeon fees.

For a fusion, a surgeon binds two or more vertebrae together using a bone graft, with or without plates and screws. The researchers defined a complex fusion as one involving three or more vertebrae or more than one side of the spine. Fusions cost $60,000 to $90,000.

The researchers analyzed data on more than 32,000 Medicare patients who had one of the surgeries. About 5 in 100 who had simple or Complex fusions suffered major complications such as stroke, compared with 2 in 100 with decompressions. The risk of death after surgery was different, too: 6 in 1,000 for complex fusions, 5 in 1,000 for simple fusions and 3 in 1,000 for decompressions.

Aggressive marketing of devices used in complex fusions is probably playing a role in the increase, Deyo said.

Allegations of questionable financial arrangements involving doctors have plagued the industry. Medtronic Inc. reached a $40 million settlement in a federal case that included allegations that the company paid doctors to use , its spine surgery products.

The company denied any wrongdoing.

Spinal study has scientists groaning about pricier, riskier fusion surgeries is a post from: Accident & Injury Law in Texas