To me a critical study remains to be done.

The study didn't address how successful the various types of surgeries were at relieving pain.

So here we go, gearing up European style socialized health care. Any health care for seniors is bad with no alternatives other than just drugging them so they will be quiet. In fairness, costs would be lower if we didn't have so many elderly on Medicare. It should be restricted to only ineligible young and healthy seniors with no long term plans.

Hospitals and physicians will continue slopping at the Medicare trough until the American public says enough. Both groups decry any and every suggestion of payment cutbacks, but they have been paid very, very well for decades. Yes, there need to be restrictions on many procedures. Cardio/thoracic and orthopedic procedures on seniors that have multiple and complex health issues is mindless, and only serves to benefit the providers. A hip replacement on a 103 year old who was confined to a wheelchair, and never got out of it after surgery??? This occurs every day across the country, and cost the taxpayers billions of dollars.

Inflammatory statements like those of coup de grace do not address the true problems at hand, they just serve to polarize the interested parties. What we as physicians strive for (the vast, vast majority of physicians) is the best outcomes for our patients. We arrive at our treatment plans via published evidence, personal experience, and to some extent, medical dogma. The arena of published evidence continues to build, though it is still fairly rudimentary for many of the medical procedures we frequently perform. It is extremely difficult to perform research studies on patients for a myriad reasons, including cost, patient consent, ethical preclusions of "sham" operations, etc. Therefore our personal experiences and dogma still have a great role to play. While I agree that more aggressive surgery for spinal pathology has been growing over the years, we do not know what is the root cause of this. Surely the aging population is one reason.

Physicians need to play a role in improving the cost:benefit ratio in medical care. This continues through research and implementation of evidenced based practices. We need help, however. We need meaningful malpractice reform so we can cut down on the useless defensive medicine that has become so rampant. We need insurance reforms, though ones focused on cutting waste and red tape and not just increased coverage which will likely just turn out to be a windfall for health insurance companies. All of these things will make the 1-2 billion spent on spinal fusions look like a tiny drop in the bucket.

So what is the point of these studies that are coming out all of a sudden? Seems too coincidental to me. Are patients, doctors and hospitals conspiring to hurt people or to help them? I lean on the side of the latter. The only beneficiaries of these studies are those that want to limit access to care for those that need it - particularly the elderly. Personally, I would submit that these people have paid for their so-called Medicare over many years, and that they are entitled to the benefits of today's medical technology. Frankly, it is the administrative costs that need reduction and not the actual care itself which is insignificant by comparison. I would agree, though, that doctors and other professionals should not accept ANYTHING from special interests so as to remain untainted, or at least the perception thereof. In private industry and in certain government jobs, $50 maximum is allowed. This should be the norm for EVERYONE employed. Bribery has its societal cost, no matter who is involved.

I had spinal fusion surgery back in 1994. Saved my life.

I had a condition where a disc in my lower neck slipped into my spinal cord in my lower neck and compressed it in half. I experienced numbness in my fingers and toes. It took an MRI to find it. Thank God for doctors like Dr. Chris Shields in Louisviile, KY, otherwise, i would be in a wheelchair or dead now.

I just had a multi level spinal fusion surgery (c2-T1) in January and as of right now I think I regret it. Never felt worse in my life, from not sleeping, pain, constipation ..you name it .. I have it .. and I had three separate opinions... surgery cost well over 100k ... don't know who to believe.. everyone is in the business of making money these days.... that's it ...

It seems very odd how all of these "studies" have been coming out over the past several months. Very odd indeed.

This is just the proof that Health Care Reform was nothing more than padding someones pocket. Back fusion works for some but only a small percentage. Health Care Reform should of included the monitoring of Medicare and it abuse, instead, Health Care Reform infused more money into Medicare.

As one who had "one of those risker" surgeries...my surgery was life changing in EVERY positive way. I have had a complete recovery, no incidents and at 55 am moving better, more active and free of pain.

I never felt this good--or pain free. So don't let this article taint your opinion. Mostly it sounds like the Obaman's trying to decide once again that "old" people deserve no care and are better off dead.

Repeal and replace.

I was involved in a auto accident in 1998 which resulted in damage to my lumbar spine. I had decompression surgery to relieve the pain. It was unsuccessful. My surgeon reccomended a pain management clinic where for the next 11 years I had injections in my spine. The pain at times was excruciating. Without going into a long explanation of the relationship between cotisone and cortisol, the injections were planned to loose thier pain relief effectiveness after 10 to 11 weeks and the injections were 13 weeks apart. You do the math. As time went on, my reliance on pain killers increased over time as my pain increased. Fortunately, I owned a successful business and was able to control the number of hours I worked. In 2008 the injections became ineffective and I was prescribed Methadone in ever increasing dosages until surgery was the only option. I had a lumbar three vertbrae fusion in February of 2009. Five days before the surgery date, I was involved in a rear end collision. The spinal fusion was successful and I was pain free for the first time in 11 years! The next hurdle was Methadone withdrawal which was an experience that I would't wish on my worst enemy. I was now pain free and pain killer free! Three months later the rear end collision manifested as my pain level went from zero to 60 in 5.1 seconds. I was in excrutiating pain, it was Friday night and I had no pain killers. I went to the emergency room of the hospital where months earlier I underwent Spinal fusion surgery. They turned me away thinking I was drug seeker. I went through pure hell until I was able to get an appointment with my pain management doctor on Monday. Which brings me to my first point.....how long would I have suffered in pain waiting for my appointment if nationalized healthcare was in effect. In November of 2009 I had cervical spinal fusion surgery which was also successful. Which brings me to my second point.....spinal fusion surgery works. I still have some discomfort in my back and probably will have for quite some time. I am now struggling with severe arthritis and am very apprehensive of what healthcare will look like four years from now. How can you cut half a million dollars from Medicare, add 30 million people to the healthcare system with less doctors than we have at present.....and not ration care?? It is simply not possible. By the way, my pain management doctor, who is in his earlt fifties has told me he will retire if and when the health careless bill takes affect. Ditto for my primary care doctor. The baby boomers are looking at the golden yaers with much trepidation. I failed to mention that during the last two years before surgery as the pain level had escalated I was unable to work at all and lost the business and eventually the family home. I was hospitalized at a mental facility for a nervuos breakdown and possible attempted suicide. I have also had two coronary bypass surgeries and a heart valve replacement. Oh, and an abdominal aortic aneurysm, all in the past 16 years. I need at least four doctors myself if you don't count audiologists, optimologists, phsychiatrists, and I,ll be lucky to get to see 2 or 3 once a year. Well, at least there may be medical marijuana which won't fix anything, but I may not care! Justice Kennedy we need your vote.....bad!

Are the viewers aware that the companies that sell these devices have sales people who actually scrub in with the surgeons during these back surgeries. Offering advice and also bringing extra equipment with them that hospitals can't afford to stock--BUT at a big cause--the American public complains about the high salaries of physicians. But in many cases these sales people with 4 years of college are making salaries that in some cases exceed the salary of the physician!!!! Its like the flight attendant commanding a larger salary than the Captain! Of course this is tacked on the price of each piece of equipment placed in your back--or your heart, if you need a stent or AICD. So each and every one of you are paying for this--even of you don't have surgery--as you insurance premiums increase to reflect the added cost Complain to your Congressman or ask your local newspaper to run an investigative story.

A neurosurgeon recently informed me that a patient required $80,000 worth of implantable equipment for a back surgery! The cost is absurd--unfortunately since hospitals are paid a fixed reimbursement fee by Medicare called a DRG, the hospital has to eats the cost and can lose a huge amount of money per case--it affects everyone, as the hospital has to raise their fees for the other patients in order to make up the difference. So we ALL pay.

I am so happy that I read this article, I have had two major back surgeries and my Dr. is really pressing the issue to have a medtronic implanted in me. they call me all the time and it's frustrating because Im so tired of being cut on... I had a feeling it was due to this but now it really answer's my thoughts about it...thank's for posting this article. I have definately made up my mind about having this implant done now. It's not going to happen.

I am not stating that these more expensive procedures are not warranted, but something needs to be done to substantially reduce the cost of the implantable orthopedic devices. Many companies have targeted $$ of minimal sales per year per a specific hospital or hospital system--if a hospital does not exceed these minimums, they get less of a discount---a cardiologist told me he was TOLD to use a specific manufacturer's AICD ( or defibrillator ), even though his professional opinion was that a competitor's product was BEST for that patient.

I had spinal fusion in my lower back (L5, S1) in Sept., '08. It took 4 years of regular visits to my doctor to complain of the pain and try to get some help for it to finally get to that point because, I guess, my doctors were conservative. I had to INSIST on a MRI so that I could show them the pain wasn't all in my head and I wasn't just out to get pain meds (X-Rays showed nothing). The MRI showed I had a bulging disc. Let me add right here that I had surgery 4 years earlier by a previous Dr. to remove a piece of this same disc that had broken off and was pinching my sciatic nerve which caused me constant pain. I moved shortly after, and was fine for awhile until my back started hurting again. But I got the impression that because I was on pain relievers for awhile after the first surgery, my new Docs thought I was making it up just to get more pain meds. Anyway, I had the spinal fusion done with a tops-in-his-field renowned neurosurgeon at OHSU. I came out of it with numbness in my right leg from the knee down. Was told that it could take up to a year to go away as it's a long healing process. I went to PT for a long time to stengthen my back and my core and other areas that were having to compensate for the numbness in my leg. Other than the numbness I did very well. Then I started back to school a year ago. All the hours I spent and spend sitting in classrooms and at home studying have made my back hurt constantly. At my one year checkup last Sept., I was told that my back was healing beautifully and that any back pain I have now is pretty much just to be expected with age (I'm in my 40's and a single mom of 3). The numbness in my leg, I'm now told, may never go away. I am STILL on pain meds (Percocet). I would love to be painfree and off meds and be able to enjoy all the things I did before all this happened. I used to be very active with my kids, bike riding, hiking, playing sports, etc. Now each day is just an exercise in trying to control the pain as much as possible and get through the day. I feel tired all the time and wonder if I'm depressed. I don't really know if the surgery helped me or not, because I don't know what condition I would be in today if I didn't have it. All I know is, I trusted my Specialized Dr., the neurosurgeon, that he knew what he was doing and what was best for me. His exact words, in fact, were "I could either have this surgery or live in pain for the rest of my life and even have it progress to other discs." I guess I'll never know, really, if I made the right decision.

it's been a tough road, if I could turn back time I would had never had back surgery. my first surgery consisted of them taking my bone marrow, I have 4 plates 8 screw's and 1 artificial disc in my back and I feel worse. 2 years later I was in a lot of pain and found out one of my disc did not fuse, only a small plastic plate was holding it together, this was a surgery I had no choice on. I am a person that has been working for the last 35 years and was still going strong. now that I have the hard ware in my back and permanent nerve damage from it, I am now on disibility...don't sleep at night. in pain all the time. injections do not help at all. funny my Dr. gave me a medtronic to try on my back. It felt really good but due to the permanent nerve damage he now want's to implant one in my back. after being hounded alot to have this done I really do believe that he is being paid for this. He is placing this item into alot of patients backs. Im discusted how the medical system works and how the doctor's are being paid off.. now I have to go in for another MRI because Im having more problems! anyone out there that read's this...if you are not in an emergency situation to where you need the back surgery and can deal with it....don't get the surgery. beside's myself I have spoken to so many people that wish they would had never had the surgery as well. Im normally a go getter...can't even do that now, it take's 2 round's of my med's just to be able to move around in the morning's and I can't do the thing's that I used to do and enjoyed doing...

Chiropractors have know about this for decades.

Our patients are the medical failures.

Study after study has shown chiropractic care to be 2 to 3 times as effective as medicine. But it's all been politics.

I'm not for national health care, but if anyting it will weed out what does work vs. what does not.

Paul Hollern

http://paulhollern.com

Got mine last October. ACDF two level. No more pain and feeling in left arm is back. Not in my fifties and thank god surgery option was there.

For several years I had pain in my legs and numbness in my buttocks. I went through painkillers, injections into my lower spine, pain management techniques, etc. Neurosurgeons in Lincoln said I'd just have to live with it. I had spondylolisthesis, deterioration of discs, and arthritis. I was 55 at the time. I went to Dr. Woodward at the Nebraska Spine Center in Omaha and told him I was not willing to live another 30 years with the pain. After a thorough assessment and explanation of options, he agreed to do surgery. I had anterior and posterior fusion, bone marrow cages, several rods and eight screws. The surgery lasted over 8 hours. There was very good follow-up, with surveys about any ongoing problems for two years. I have been pain-free for six years. I can't say enough good about it.

Expensive? Yes. But I had good doctors and the repair should last for the rest of my life. I'm saving the expense of painkillers, therapy, shots and suicide intervention. I'd be suspicious of doctors who keep pestering someone to have surgery. If it hurts bad enough, they won't need to pressure you. Anyone who needs the surgery should have access to it and insurance to pay for it.

Some people who say back surgery didn't work for them had only posterior fusion or their doctors weren't that good. My nephew's partial fusion broke down and he had to have posterior and anterior fusion anyway. After the second surgery, which was several years ago, he's doing great.

Sorry but after an attack by a student in 2001 my back suffered severe trauma. I could barely walk and was in excruciating pain. As my situation fell under the aegis of workers comp, I was sent to every sort of practitioner: chiropractor, physiatrist, physical therapist and for what? For eight years my conditioned deteriorated. My employer moved me from my regular position and stuck me in an assignment designed to "encourage" my retirement. I sought out a neurosurgeon who informed me if I did not get a three level fusion I would end up crippled. Workers comp rejected his opinion and sent me to a neurosurgeon of their choice who happened to be the head of neurosurgery at a hospital in Fairfield county in Connecticut. His first words to me were,"Why are you in my office? Who need a fusion.'

He agreed to perform the surgery and as this was the surgeon picked by workers comp they were now in a bind. The surgery was performed a year ago 17 March 2009. I can walk. I can stand. After eight years of being in the worst pain I was free to begin again at age 64.

As a sidebar, while this gifted man returned me to life, he informed my employer I should be returned to my former position which would place me back in a safe and secure workplace. However, my employer redoubled their efforts to place me in positions that put me at risk for further injury designed to hasten my exit.

The surgery was a success; it was who I worked for that were seeking failure.

Spinal fusions have come a long way since my last one in 1985. People should not go in to them lightly and you need to do your research, and the severity of these surgeries should not be taken lightly. I have had three and with out them i would not be here today and would not have my children. Yes i am still in pain today and will be in pain for the rest of my life but I keep going and am happy with the the results of the surgeries that i have had.

I am having spinal fusion July 26th & I am so scared I am 67 years old and have never had any kind of surgery. I have severe back & nerve pain only on the left side. My doctor wants to do a level one spinal fusion with graft. Should I do this I have not had a second opinion I belong to Aetna Medicare HMO. Please give me any feedback you have.

I had spinal fusion approx 3 months ago after two failed decompression op's and steroid injections ! It has given me my life back ! but not without a hell of a lot of serious pain ! and i'm still recovering ...