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 you.
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."