Are Many Spinal Surgeries Unnecessary?

Spinal surgeries are risky procedures that require hours under anesthesia, and days of hospitalization, so no patient likely takes the decision to undergo such surgery lightly. Most are following their doctors’ recommendations, but such recommendations are coming under increased scrutiny.

Chronic back pain-one of the common complaints that cause doctors to recommend spinal surgery-is one of the top 10 diseases in the US according to It is also one of the most expensive: Americans spend $32 billion per year treating back pain, including spinal surgeries. These spinal surgeries have the potential to result in serious complications including spinal cord injuries.

Dramatic Increase in Spinal Surgeries

A recent study published in the Journal of the American Medical Association found that complicated spinal fusion surgeries were 15 times more prevalent in 2008 than in 1997. With the increase in procedures came an increase in cost. In 1997, spinal fusions cost the Medicare program $343 million; in 2008, the same procedures cost Medicare $2.24 billion.

Potential Problems of Physician-Owned Distributorships (PODs)

Although the rise in surgeries seems to indicate that people are experiencing more back pain now than a decade ago, some legislators believe that another, more legally questionable reason, may be the actual cause for the increase in spinal surgeries. Senators Orrin Hatch (R-UT), Herb Kohl (D-WI), Charles Grassley (R-IA), Bob Corker (R-TN), and Max Baucus (D-MT) have asked the Inspector General to investigate the legal validity of physician-owned distributorships, or PODs.

A physician-owned distributorship acts as a liaison between medical device manufacturers and hospitals. Distributorships receive a kickback from the device manufacturers every time they successfully market a device to hospitals. Often, physicians own these types of distributorships.

There is one looming problem with PODs. Physicians, including surgeons, usually decide what devices their hospitals purchase. If a physician owns a distributorship, that physician has a financial incentive to order devices for which he or she would receive a kickback, and may be more inclined to recommend unnecessary surgeries that use the devices. This is why senators want to investigate whether or not PODs are legal.

Action Being Taken

At least one hospital system has already put an end to PODs. Martin Memorial Health Systems in Stuart, Florida, has ceased to do business with physician-owned distributorships, claiming they go against the “spirit” of the federal anti-kickback statute, which is designed to protect consumers from the “corrupting influence of money on health care decisions”. The law states that physicians and other medical professionals cannot receive payment for referring hospitals or patients to certain services within the federal health care system. This includes physicians that treat Medicare and Medicaid patients.

Spinal surgeries are risky procedures, and research suggests that up to 90 percent of them are unnecessary. As with any medical procedure, it is important discuss all your options with your doctor and research potential risks and benefits. After consulting a medical professional, people with persistent back pain may want to visit a chiropractor, physical therapist or explore alternative treatment before resorting to spinal surgery.