Physician Panel Sees Bias Toward More Invasive Fusion Surgery over Less Invasive and Less Expensive Options for Chronic Lower Back Pain

PADUCAH, Ky., Feb. 23, 2006 ―Insurance companies favor fusion surgery over back pain management therapies, according to a recent panel of orthopedic surgeons, interventional radiologists, physiatrists, and pain management specialists from leading academic centers nationwide. Yet fusion surgery is often more than ten times costlier than other methods of managing chronic discogenic lower back pain 1. The panel discussed and examined pain management strategies from medical specialties that routinely work with patients suffering from chronic lower back pain.

In discussing their treatment options for patients with chronic discogenic lower back pain, panelists agree that the first course of treatment should always be physical therapy and/or chiropractic, muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs). If the patient doesn’t respond to these treatments in four to six weeks, most of the panelists agree minimally invasive procedures should be considered. Panelists also agree that the last treatment to consider is fusion surgery, which fuses two or more damaged discs together, reducing or eliminating pain, but can also cause potential complications such as nerve damage and treatment failure.

The panel of physicians also concludes that there is a bias toward the higher cost fusion surgery option. This bias is the result of several factors; in particular, insurance companies opting to pay for more invasive treatments, rather than minimally invasive or pain management procedures, even though those pain management protocols and procedures are considerably less expensive and may be more clinically relevant.

“Fusion surgery has become so prevalent because it treats the condition of discogenic back pain in an obvious way,” said Dr. Nagy Mekhail, a pain management specialist at the Cleveland Clinic in Cleveland, Ohio. “However, the healing time, the cost, and the reduced flexibility associated with fusion surgery makes alternate, less invasive options an important consideration in a patient’s continuum of care.”

A 1999 study in the Journal of the American Medical Association(JAMA) titled, “Avoiding the Unintended Consequences of the Growth in Medical Care,” bears these findings, as do market data. The study found that while many believed that more medical care must lead to improved health and well-being, this thinking has also led to more expensive, surgical procedures. 2 For example, it is estimated that more than 200,000 spinal fusion surgeries are performed each year in the United States. The cost for each surgery ranges from $50,000 to $70,000.By comparison, a much less expensive, but effective and less invasive procedure called Intradiscal ELECTROTHERMAL Therapy * (IDET *) costs approximately $7,000, but only between 5,000 and 7,000 of these procedures are performed each year.

Participants in the panel discussion included pain management specialists, spine surgeons, interventional radiologists, and physiatrists from various organizations such as the Albany Medical College in Albany, N.Y., the Cleveland Clinic, Columbia University in New York City, Johns Hopkins Hospital in Baltimore, Rush Presbyterian-St. Luke’s Medical Center in Chicago, Mayo Clinic in Jacksonville, Fla., UCLA/Cedars-Sinai Institute for Spinal Disorders in Los Angeles, and Stanford University in Stanford, Calif.

The panel was conducted by MedPanel, an online medical market research company in Cambridge, Mass., that convenes online physician panels to gain insights into various healthcare and clinical issues. The discussion was sponsored by The American Society of Interventional Pain Physicians (ASIPP) and Smith & Nephew Endoscopy. For more information, please contact Gena Henderson, MS&L, gena.henderson@mslpr.com, or 617-937-2584.

About The American Society of Interventional Pain Physicians (ASIPP)

The American Society of Interventional Pain Physicians is a not-for-profit organization representing interventional pain physicians across the country. ASIPP’s mission is t o promote the development and practice of safe, high quality, cost-effective interventional pain management techniques for the diagnosis and treatment of pain and related disorders, and to ensure patient access to these interventions.

• “The average cost to the payer for the IDET procedure from start to finish, which includes facility fee as well as professional fee, is approximately $7,000 to $8,000. The cost of fusion surgery is reported to be 3 to 10 times that amount.” Wisconsin Medical Journal, volume 101, No. 1 WMJ. 2002
• JAMA , “Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse”, Elliott S. Fisher, MD, MPH, H. Gilbert Welch, MD, MPH, February 3, 1999