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Spine expert comments on dramatic increase in complex back surgeries

A new study showing a dramatic increase in complex back surgeries among older adults is being widely reported on this afternoon. The research, published in the Journal of the American Medical Association, shows that:

The operation, complex spinal fusion, accounted for 14.6 percent of all back surgeries for Medicare patients in 2007, up from less than 1 percent in 2002... Patients who underwent the procedure showed a doubled rate of life-threatening complications, 5.6 percent, compared with a simpler back surgery called decompression.

In an accompanying editorial (subscription required), Eugene Carragee, MD, Stanford's chief of spinal surgery, explains that the majority of patients - the ones without complex deformities - can be effectively treated with decompression. Yet the study shows half of the more complex operations were done on patients without deformities:

Newer and more complex technologies are being used for patients with little specific indication for the approaches and for whom there is good evidence that simpler methods are highly effective.

When talking with a colleague this afternoon, Carragee gave his thoughts on the possible reason for all those complex procedures:

“There are a lot of incentives to do large operations for surgeons, and it’s not just financial. There are marketing campaigns by the industry to use the more complex technologies, but I think it's also an innate part of surgical practice... to want to do the newest things. And often patients will ask for these procedures.”

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