Surgeons warn of 'overutilization' of spinal fusion


Spinal fusions are a common option for addressing back pain and spine conditions. But some spine surgeons worry that the procedure could be overdone.

Although spine surgeons went to medical school to learn operative treatment, sometimes it might be better to find options to avoid surgery.

"One potentially dangerous trend in spine and orthopedics is the overutilization of certain surgical procedures, such as spinal fusion, which may not always be necessary or beneficial for patients," said Ernest Braxton, MD, of Vail (Colo.) Summit Orthopaedics and Neurosurgery. "Overutilization can lead to unnecessary risks, complications and healthcare costs. This trend can be exacerbated by the concept of moral hazard, where the availability of insurance coverage or financial incentives may influence surgeons to recommend or perform surgeries that may not be medically necessary."

Unnecessary spinal surgeries, which are defined as any surgical intervention that is either not needed, not indicated, or not in the patient's best interest, have grown with estimated 50 percent of lumbar spine surgeries deemed unnecessary. 

In the first year of the COVID-19 pandemic, more than 30,000 unnecessary spine surgeries were performed, according to a report from the Lown Institute. For spinal fusions for back pain, there were 13,541 cases performed that were considered "unnecessary."

"To address this trend, there is a growing emphasis on evidence-based medicine, shared decision-making and professional guidelines among spine surgeons to ensure that surgical interventions are used judiciously and appropriately," Dr. Braxton said. "By promoting a more conservative and selective approach to surgery, spine surgeons can help mitigate the risks associated with overutilization and ensure that patients receive the most appropriate and effective care for their condition."

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