Back pain is a common ailment for which many Americans seek medical help. Spinal fusion surgery is a common treatment. Between 2001 and 2011, the number of spinal fusion surgeries performed in the US went up by 70 percent making it even more common than hip replacements. Among the reasons for spinal fusion's popularity is the aging American population along with the fact that today's seniors demand mobility. The procedure is not without controversy, critics suggest that some surgeons are performing it unnecessarily and that spinal fusions are potentially dangerous. The procedure involves fusing two or more vertebrae, typically with metal rods or screws. The danger is that the patient may suffer paralysis or deadly complications.
For many years, patients were not informed as to the likelihood of a spinal fusion surgery recommendation, or whether their doctor might be performing unsafe procedures. They had no way of examining their doctor's track record with spinal fusions or the percentage of patients on which they had performed the procedure; they also had no way of knowing how many they performed compared to other doctors.
The data compiled in a recent CBS report shows that a small number of doctors performed the procedures far more often than their peers. The average for doctors across the country was 46 spinal fusions over two years, but some performed more than ten times that. The average spine surgeon was found to perform the surgery on seven percent of their patients, but some performed them on as much as 35 percent.
There are several good reasons why a doctor may perform a disproportionately large number of spinal fusions. Some treat cases that are more difficult and get a large number of referrals. Some may be operating on patients that have been refused the surgery by other doctors. Spinal fusions are financially rewarding for surgeons, they can earn thousands of dollars more than they would by using safer alternatives.
Surgeries that involve the fusion of more than four vertebrae are more complex and this is where much of the controversy is focused. More vertebrae equals more money for the surgeon; however, the added complexity makes the procedure riskier for the patient. A study of spinal fusions used to treat narrowing of the spinal canal (stenosis) found that one in every 20 resulted potentially fatal complications. When it came to procedures with a greater degree of risk, the gap widened even further between the surgeons. Some performed more than 100 of these procedures; the national average is seven.
According to Dr Daniel Resnick of the University of Wisconsin School of Medicine, these numbers suggest that while most surgeons are cautious about recommending fusions, a minority may be operating beyond generally agreed upon parameters. He has also said that doctors who perform the surgery the most should be scrutinized and asked to provide reasons.
CBS has compiled a database that enables you to find the operating rates of spinal surgeons all over the country. Among the surgeons investigated and who were found to have performed spinal fusion surgery at a high rate are:
In 2010, Dr McCord of Nashville, Tennessee performed a spinal fusion on Barbara Jo Smith, a patient with severe spinal pain. He used plates and screws to fuse three of her vertebrae. Five months after, Smith says that her pain worsened. She returned to Dr McCord who performed another fusion. The patient says that she is in far more pain today than before the surgeries. Two other doctors who were asked about Barbara Jo Smith's case stated that they would not recommend spinal fusion for her diagnosis. Dr McCord operated on 20 patients three or more times, twice as many as any other surgeon in the country.
Dr Omar Jimenez of Scottsbluff, Nebraska performed the third most spinal fusions in the country, 325. Dr Jimenez was suspended by a network of five hospitals in Georgia in 2006 and has settled two malpractice suits in that state. One of his patients suffered permanent nerve damage after spinal fusion surgery.
Dr Mathew Alexander of Corpus Christi, TX performed the fourth most fusion surgeries on more than four vertebrae, 97. Kimberly Keith was suffering from severe pain in parts of her upper body when she visited Dr Alexander. He performed a fusion from Keith's skull and through six vertebrae. Keith is now unable to move her head. Other doctors have stated that a correction would involve undoing the fusion with significant risk to the patient.
Dr Richard Hynes of Melbourne, Florida performed the third most fusions on four or more vertebrae of anyone in the country, 107. One patient whose complications resulted in a part of her intestine being removed has sued Hynes. He also has made payments that total more than $500,000 to former patients.