“Unnecessary” Spinal Surgery:
A Review With Commentary
SOURCE: Surgical Neurology Internat 2011; 2: 83
Nancy E Epstein, Donald C Hood
Department of Neurological Surgery,
The Albert Einstein College of Medicine,
Bronx, NY, USA
INTRODUCTION: Although one spine surgeon may decide that a patient needs surgery, another surgeon [e.g. a second opinion] might decide that surgery is “unnecessary”. Here we define “unnecessary surgery” as spinal surgery based upon “pain alone”. That is, the patient has no neurological deficit and no significant abnormal radiographic findings on dynamic X-rays, MR, and/or CT. Surgeons can, and do, debate whether it is appropriate to operate on patients with pain alone. To put this debate in context, however, we need to better understand the number of patients involved and the type of procedures recommended. In this prospective study performed over a one-year period, a single neurosurgeon documented the “unnecessary” lumbar and cervical surgeries planned by other spinal surgeons.
BACKGROUND: There are marked disparities in the frequency of spinal surgery performed within the United States over time, as well as across different geographic areas. One possible source of these disparities is the criteria for surgery.
METHODS: During a one-year period [November 2009-October 2010], the senior author, a neurosurgeon, saw 274 patients for cervical and lumbar spinal, office consultations. A patient was assigned to the “unnecessary surgery” group if they were told they needed spinal surgery by another surgeon, but exhibited pain alone without neurological deficits, and without significant abnormal radiographic findings [dynamic X-rays, MR scans, and/or CT scans].