Surgeons have increasingly turned to complex surgical procedures to treat back pain over the past 6 years, but a study has found that such procedures pose greater risks and are more expensive than simpler treatments without offering significantly higher benefits.

Spinal stenosis of the lower back, a narrowing of the spine, is a fairly common cause of lower back pain in people over the age of 50. The narrowing causes pressure on the nerves or spinal cord. To relieve the pain from this pressure, patients can be treated by decompression, a simple procedure that involves removing bone fragment. Decompression can also be accompanied by fusion—the welding together of two problem bones.

While these simple operations are generally successful at treating the pain caused by spinal stenosis, in recent years surgeons have been employing more complex procedures. These complex procedures involve fusions with various implants.

In a study of Medicare claims for surgical procedures for lumbar spinal stenosis between 2002 and 2007, researchers found that there was a significant drop in the number of simple decompression and fusion procedures, and a rise in complex procedures. There was also a 40% rise in total hospital costs for these complex procedures. Only 2.3% of patients undergoing simple surgeries suffered complications, while 5.6% of patients having complex procedures were afflicted by complications. Complex procedure-patients were also twice as likely to have to return to the hospital after their initial operation.

The cost of complex procedures is also much higher. Due to longer hospital stays, patients who had complex fusions had average hospital costs of $80,888; simple operations accrued average bills of only $23,724.

Translating research into practice

Researchers concluded that the extra cost and risks of complex procedures are not justified, and simpler procedures should be employed more often. When examining why surgeons use complex procedures so often, the researchers came up with several theories. There are financial incentives for surgeons that favor complex procedures. Manufacturers of surgical implants and devices encourage surgeons to use their products in complex fusions. Matters of pride also appear to influence surgeons to perform more complex procedures.

Before deciding on the appropriate treatment course for spinal stenosis, both surgeons and patients should consider the risks, benefits, and costs of each treatment option.