Ethics in Medicine

Tiger Woods Won the Back Surgery Lottery

Kristen Sparrow • May 16, 2019

That is the actual title of this very important discussion of spinal fusion surgery.  Go the acupuncture route.  Safer, cheaper, no opioids involved. Reading through this article, I want to copy almost the entire thing.  This is information that is crucial and to call it “under-reported” is the understatement of the decade.

An outcome like his from fusion surgery is so rare it is “like winning the lottery,” Dr. Sohail K. Mirza, a spine surgeon at Dartmouth, said…

If you look at it simplistically, what does fusion do? It provides mechanical support,” said Dr. Charles A. Reitman, co-director of the Spine Center at the Medical University of South Carolina. “If they are missing mechanical support and that is the pure cause of the problem, then they will get better.”

People with a broken spine, for example, or scoliosis, which is severe spinal curvature, or spondylolisthesis, in which vertebrae slip out of place, tend to have terrific results, he said.

But those are a tiny minority of fusion patients. The vast majority of fusion procedures are performed on patients with one or more degenerated disks, disks that are worn out, dehydrated, stiff and friable. And when those disks move, patients’ backs can ache…

And at least half of patients in pain who have a fusion for a degenerated disk remain in pain…

Disabling lower back pain from degenerated disks often improves on its own, eventually. It’s not clear why because the disk is still degenerated. But the pain diminishes or even goes away…

Some, like Dr. Atlas and Dr. Mirza, say they try to talk most back pain patients out of fusion surgery, urging them to try conservative treatment first.

Dr. Steven Hughes, a spine surgeon in general practice in Northern Virginia, says careful patient selection for fusion surgery is crucial. He offers back surgery to only two or three of the 100 to 120 patients a week who come to him with back pain.

“If you are in a good surgeon’s office, fusion is the last thing you will be offered,” Dr. Hughes said.

“By middle age almost everybody has disk degeneration and a lot of people have back pain, but science has not been able to link the two,” Dr. Mirza said. “That’s the problem with fusion surgery for disk degeneration.”

Tony Delitto, dean of the University of Pittsburgh’s School of Health and Rehabilitation Sciences, says he tries to warn patients seeking fusion surgery for a deteriorated disk not to expect too much.

“I would be very, very hesitant, and most surgeons would be very, very hesitant to tell patients that after fusion they would be pain-free,” he said.

Dr. Richard Deyo, an emeritus professor of medicine at Oregon Health and Science University, and his colleagues conducted a study in Oregon and found that about half of fusion patients who had the procedure on their lumbar, or lower, spine were using opioids before their operations. After their surgery, only 9 percent stopped using the drugs. And 13 percent who had not used opioids became long-term users after the surgery.

It’s hard to know what constitutes success, Dr. Deyo said. For example, one study, one of whose co-authors was Richard Guyer of the Texas Back Institute, who was widely reported to be Woods’s surgeon, reported a “clinical success rate” of 57 percent after two years. It defined clinical success as at least a 25 percent improvement in overall functioning, with no device failure, no major complications and no neurological deterioration.