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Old 04-07-2010, 08:07 PM
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Is costlier spinal surgery worth it?

By Carla K. Johnson

Associated Press

CHICAGO - 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.

"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," said Eugene Carragee of Stanford University Medical Center.

Add to that the expense for patients whose problems after surgery send them back to the hospital or to a nursing home, and "that's not a trivial amount of money" for Medicare, Carragee said. He wrote an accompanying editorial in the Journal of the American Medical Association, where the federally funded study appears Wednesday.

The cost to Medicare, just for the hospital charges for the three types of back surgery, is about $1.65 billion a year, the researchers say.

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

"Some seem to be associated with higher complication rates than others," said lead author Richard Deyo of Oregon Health and Science University in Portland. "It's not necessarily true that the more aggressive surgery is better."

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 and with less risk?

In a decompression procedure, the simplest method in the study, a surgeon cuts away part of the bone that is painfully 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 three surgeries in 2007.

About 5 in 100 patients who had simple or complex fusions suffered major complications such as stroke, compared with 2 in 100 with decompressions. The risk of death within 30 days 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.
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