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Complex Spinal Operations Soar Despite Drawbacks
Date:4/6/2010

Greater hazard, no more benefit, experts say

TUESDAY, April 6 (HealthDay News) -- The use of complex surgical procedures to treat back pain has exploded in the past six years, even though these operations are riskier and more expensive than simpler treatments and not necessarily more effective, a study finds.

"It was a bit of a surprise to see how big the increase was," said Dr. Richard A. Deyo, professor of family medicine and internal medicine at the Oregon Health and Science University and lead author of a report published April 7 in the Journal of the American Medical Association. "A 15-fold increase over a short period of time was more than we expected."

Several possible explanations exist for the increase, money among them, Deyo said. "There are financial influences at play," he said. "You get paid more for complex procedures."

Surgery is sometimes necessary for spinal stenosis of the lower back, a narrowing of the spine that typically afflicts people over 50. Pressure on the nerves or spinal cord can cause pain. The simplest procedure is decompression, which involves removing bone fragment. It is sometimes accompanied by fusion, in which two problem bones are welded together. More complex fusion procedures can involve a variety of implants.

The study by Deyo and his colleagues looked at Medicare claims for surgical procedures for lumbar stenosis between 2002 and 2007. They found that overall the number of operations decreased slightly, from 137.4 per 100,000 Medicare users in 2002 to 135.5 in 2007, with the drop noticeable among the simpler decompression and fusion procedures.

But the rate of complex procedures rose from 1.3 per 100,000 in 2002 to 19.9 per 100,000 in 2007, a 15-fold increase.

That increase accompanied a 40 percent rise in total hospital costs for such surgery, the study found. In addition, 5.6 percent of those having complex procedures suffered complications, comp
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