Complex Spine Surgery in Older Folks

phillips_coverShould you have surgery on your lower, or lumbar spine? For many, if not most people, the accumulated evidence from several studies seems to conclude that a conservative intervention known as 'decompression' is okay, but the more complex procedure known as 'fusion' isn't very helpful and may actually be harmful in the long term. Now a study in JAMA demonstrates that among Medicare recipients, the rate of complicated fusion procedures on the lumbar spine has increased by a factor of 15.

That's right, there are 15 times more complex surgeries taking place in the 2002-2007 period than took place before, while the actual number of surgeries for low back problems declined as did the more simple decompression or simple fusion. And the news gets worse as other measures such as 30 day mortality or major complications were also increased in those who underwent the complex fusion.

Yikes. What's going on here? How do we account for this dramatic increase in complex fusions in a vulnerable population of people? The authors very charitably suggest that surgeons may believe that a single, more complex operation will reduce the likelihood that the person will need another operation later on, and are persuaded that newer prosthetic devices, better anesthesia and the like will offset the risks of the more dramatic operation.

The authors also state, however, that their study suggests that use of the most conservative approach that can relieve pain should be the objective. Rick and I suggest in the podcast that patients need to very carefully weigh their options when it comes to spine surgery, and most definitely get more than one and perhaps more than two opinions on the best way to manage lumbar back issues. Long term studies on back interventions have shown that when outcomes are examined five years later, they're often the same for surgical versus nonsurgical approaches, which can include physical therapy, weight loss pain medications and others.

Other topics in this week's podcast include mothers and their believes about infant sleeping positions in this issue of Archives of Pediatric and Adolescent Medicine, overcoming the obesity gene with exercise in the same journal, and lung function in folks involved in 9/11 rescue efforts in NEJM. Until next week, y'all live well.

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disk replacement surgery June 30, 2010 at 5:28 am

Informative post. Good insight provided on lumber spine. Good statistics collected.Thanks for sharing. Keep posting.

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