The Truth About Back Surgery
Such activities affect the treatment you receive.
"Kickbacks...corrupt physicians' medical judgment," said Peter Keisler,
assistant attorney general for the Department of Justice's civil division, in
announcing the Medtronic settlement. And these physicians can, in turn, sway
other doctors' decision-making. "These are often prominent surgeons, the ones
in leadership positions in medical societies and on the boards of major
journals," says Dr. Rosen, who is also founder and president of the Association
for Medical Ethics. They write the articles that drive treatment methods and
device acceptance — influence that undoubtedly contributes to a vast number of
unnecessary operations. In the U.S., more than 1,150,000 people go under the
knife for spinal problems every year, a rate double that of most developed
countries and five times that of the United Kingdom, says Dr. Deyo. Yet the
outcomes have been no better. "Maybe 5 percent of patients with back pain need
surgery," says Dr. Rosen.
So whom can you believe, and what does help? There's little
consensus. Indeed, last June, when the prestigious Institute of Medicine
announced it would evaluate the effectiveness of approaches for 100 health
issues, lower-back pain was placed in the "highest priority" group.
There is no one best way to treat everyone. But the chance of finding relief
for ongoing pain unquestionably lies in understanding what has gone wrong —
often not an easy task — and then seeing the most appropriate specialist for
your problem and asking the right questions. With back problems, perhaps more
than with any other medical condition, getting the best care really is up to
Danger Ahead: The Diagnosis
Back surgeries can fail for a devastatingly simple reason: The operation was
not the right treatment, because the surgeon never pinpointed the source of the
pain. As a result, patients may be just as miserable as they were before — or
worse off — and a desperate number choose to try again. By two years after
their first surgery, about 8 percent of patients have had another operation; by
10 years after, the rate jumps to 20 percent, an analysis of Washington State
hospital data found.
That's why it's critical to have a thorough workup — to get a sense of the
root cause of your pain, says Arnold J. Weil, M.D., director of the
Non-Surgical Orthopaedic & Spine Center in Atlanta. X-rays and MRI scans
can be helpful, too — but only if your doctor has good reason to suspect a
particular problem. Go on a fishing expedition, and you could end up with the
wrong diagnosis — and ineffective treatment. That's because high-tech images
routinely uncover bulging discs and other scary-looking "abnormalities."
Trouble is, those often have nothing to do with what's hurting. "If you took
100 people off the street and gave them MRIs, a third of them — even if they
had no back pain whatsoever — would have obvious structural problems," says Dr.
Rosen. At best, your doctor might be misled by your abnormal X-ray or MRI, or
hope that the abnormality is the cause of your pain and that by fixing
it, he'll make you better. At worst, says Dr. Rosen, "the doctor knows full
well that the image could be a red herring, but the chance to 'fix' something,
and get paid for it, is just too good to pass up."