Spine surgery…

Spine surgery

Dr. Michael J. O’Connell, New Hampshire, commented that spine surgery is gaining a lot of attention by Medicare and other health insurances as part of the push for evidence based medicine and treatment policy restrictions, and deservedly so. Several large randomized controlled studies have been quite consistent in demonstrating the limited value (barely statistically significant) of spine surgery in general, to include dorsal decompression for stenosis, fusion for degenerative disc disease, discectomy/laminectomy for herniated and protruding discs, and sacroiliac fusion.  It is difficult to find a well performed study from the past decade that demonstrates anything more than modest advantages to surgery for almost all maladies of the spine; acute unstable fractures aside.  One recurring theme of all the available research on spine surgery outcomes is that the follow up of the patients is often six months or one year post op at most.  Many patients who underwent surgery are relatively happy with immediate gains.  However when queried after a year, reports of recurrent pain are typical.  This is not different pain; it is the same pain, same location, character, and exacerbating factors.  More alarming is the development of additional or new pain on top of the recurrent pain following surgical approaches.

Well, you might say that recurrent pain is the risk one takes, signs up for, when considering spine
surgery.  While true, society needs to weigh in, particularly in this new age we live in where all medical treatments are scrutinized for cost effectiveness.  Spine surgery is extremely expensive, once the total costs are added up:  the surgeon’s fee, anesthesiologist’s fee, enormous hospital charges, and then rehabilitation/physical therapy required post op.  Sadly, for a significant poSpine surgery 3rtion of patients, this is not the end of the costs incurred.  Re-operation is relatively common, to treat recurring pain (e.g. Bill Walton), to treat pain that was never relieved even in the immediate post op period (e.g. Tiger Woods), to remove hardware (usually thought erroneously to be the cause of continued pain after fusion), to drain abscesses from operative infection, fusions required after multiple laminectomies for the resulting destabilization, the list goes on, and on, and on.

You might ask why we haven’t heard more about the vast failures of spine surgery.  The answer to that is multifactorial.  First and foremost, surgeons earn a great deal of money chasing down reasons to operate.  After all, they were trained not to medically treat spine related pain, but rather to cut.  So there are a tremendous amount of resources held by the astounding 6,000 spine surgeons (estimated, difficult to get hard numbers) we have in this country.  Second, hospitals make a pile of money supporting these surgeries through facility fees.  Third, a lot of peer reviewed spine surgery journals have “reviewed” and printed innumerable studies supporting the value of spine surgery for nearly anyo

spine surgery 4ne who walked on two legs and had axial pain.  These journals now have a vested interest and built in bias toward preserving spine surgery as a cash cow.  Needless to say, manufacturers of fusion devices are huge stakeholders.  Vast organizations that cater to conferences on spine surgery also have a hand in the pot.  In other words, money is at the root of the fact that the US performs vastly more spine fusion surgeries than any other industrialized country, and yet has vastly more disability from spine pathology.  Does this fact alone reveal a problem with the surgical approach?  Is much of spine surgery little more than wishful thinking?

 

About Dr. Michael J. O'Connell, New Hampshire
Dr. Michael J. O'Connell of Barrington, New Hampshire, has forged a distinguished career spanning over three decades, as entrepreneur, physician, businessman, philanthropist and healthcare consultant. As former owner, administrator and CEO of a 225+ employee multi-specialty medical practice, Dr. O'Connell has dedicated his entire professional life to helping patients with family medicine and especially those experiencing chronic pain and all aspects of addiction. Since selling his family of healthcare businesses, he has never once contemplated retirement despite his rich and fulfilling journey, but instead has turned his focus to consulting in an industry starved for courage and creativity. Having weathered many political, technological and legal challenges, there is hardly a storm he has not confronted, a tempest he has not quelled, an urgent need he has not met. While the talking heads and self-proclaimed experts in the field have assumed the conventions and standards of the times, Dr. O'Connell does not believe in merely reflecting the herd mentality, but rather in leading the charge. Eschewing political correctness, Dr. O'Connell says and does what needs saying and doing, and not what the mindless masses expect. In addition to the continual education afforded by his variegated life experiences, Dr O'Connell earned his BS in Biochemistry at the University of NH in 1975, his Medical Degree from Dartmouth College in 1981, interned at Walter Reed Medical Center in 1982, Residency/Fellowship at UCSF in1986, and finished his Masters in Healthcare Administration at UNH in 1995. Dr. O’Connell enjoys many outdoor activities, including rock climbing, snowboarding, hiking, and golf. Through the decades Dr. O'Connell has supported many non-profit charities to include the St. Charles Home in Rochester NH, the Tri City VNA and Hospice, Hyder House, and Cocheco Valley Humane Society. To the latter organization alone Dr. O'Connell has donated over $180,000 and pledged another $250,000 in the “Bring-Us-Home” campaign for a new building. His “Matching Donations Christmas drive” has generated over $175,000 in charitable giving from the community. In addition Dr. O'Connell has participated in many dozens of other volunteer and donation efforts locally as well as in Africa and the Dominican Republic. For a listing of how I gave back to the community during my career and continue to do see: https://michaeloconnellmdnh.wordpress.com/

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