Is Spine Surgery Under Assault?

Article preview from IN VIVO - May 2008

Find out why a recent article published in JAMA has spine surgeons crying foul?

The article contends that spending on spine care increased 65% between 1997 and 2005--no big surprise given that healthc are spending in general increased by a similar amount over the same period. But an aggressive PR campaign behind the article seemed to single out surgery as a prime culprit in the rising costs and carried a clear message: that we're spending a lot on spine surgery and getting little in return. Moreover, claim surgeons, the article is just the latest in what they see as a larger campaing to cast doubts on the value of spine surgery and deny care to patients.

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According to a recent article in the Journal of the American Medical Association, expenditures for back and neck problems increased 65% (adjusted for inflation) between 1997 and 2005, with little or no improvement in patient outcomes, based on the patients' own self-assessments. The authors' conclusion was clear: we're spending a lot of money on spine therapies and getting almost nothing in return.

The article, which appeared in the February 13, 2008 issue of JAMA, was written by Brook Martin, MPH from the Center for Cost and Outcomes Research at the University of Washington and Richard Deyo, MD, MPH, department of family medicine at Portland's Oregon Health & Science University, along with some others. And it no sooner hit the stands than surgeons started crying foul. (Deyo is the one physician among the article's seven named authors.) It wasn't the conclusions of the study that had them so concerned, but something bigger: what many surgeons today see as a concerted campaign on the part of a handful of researchers, in complicity with leading clinical journals such as JAMA, to denigrate the value of spine surgery and, worse, to put just about the worst possible spin on the researchers' findings—all in an effort to reduce health care expenditures by denying patients access to care.

Indeed, say some spine surgeons, the JAMA article should never have been published in the first place. For one thing, it contains a number of methodological flaws—for example, although the economic data on spine expenditures came from the Medical Expenditure Panel Survey (MEPS), the quality-of-care assessment came from a completely different source, thus leading researchers to base their conclusions on two different patient populations. For another, more than half of the patients who said they were suffering from spine problems couldn't offer a specific diagnosis for their problems, making it impossible, say surgeons, to draw meaningful conclusions both about the health status of the patients and the effectiveness of any treatment they received.

Even more worrisome, the implicit premise of the research—that spine therapy costs are out of control—is belied by the researchers' own findings because the data show that spine expenditures increased no faster than overall health care costs during the same period. If spine costs are out of control, so is health care spending in general. At the same time, surgeons argue, in drawing their conclusions, the researchers ignored a growing body of data from randomized clinical trials that prove just the opposite: that new spine therapies, properly applied, are demonstrably helping patients.

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