David Spodick, MD, professor of medicine at the University of Massachusetts, has stated: "Surgery is the sacred cow of our health-care system and surgeons are the sacred cowboys who milk it."³³ Indeed, spine surgery has become the cash cow in the medical world and will only grow larger unless sensibility prevails over profiteering.

In reality, doctors and hospitals are making huge profits off the backs of unsuspecting patients who are not told there may be better and cheaper ways to solve their back pain with chiropractic care or other non-invasive methods. The costs of back surgeries are among the most expensive, and these costs do not include hospitalization, imaging, drugs or medications:³⁴

• Anterior cervical fusion: $44,000
• Cervical fusion: $19,850
• Decompression back surgery: $24,000
• Lumbar laminectomy: $18,000
• Lumbar spinal fusion: $34,500

Deyo found that the mean hospital costs alone for surgical decompression and complex fusions ranged from $23,724 for the former to $80,888 for the latter.³⁵ When combined with surgical costs, medications, MRIs, rehab, and disability, every spine surgery case approaches $100,000 or more. The direct costs are astronomical and may reach as high as $169,000 for a lumbar fusion, and for a cervical fusion as high as $112,480.³⁶

Research suggests that of the 500,000-plus disk surgeries performed annually, as many as 90 percent are unnecessary and ineffective.³⁷ This is unsustainable, and yet growing at incredible rates. Deyo noted, "It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just six years," and he mentioned one strong motivation included "financial incentives involving both surgeons and hospitals."³⁸

In the current era of evidence-based medicine, it is difficult to understand the huge increase in spine fusions considering their high costs, poor outcomes and increased disability costs. Indeed, it certainly appears we have now entered into the era of economic-based medicine instead of evidence-based. Despite the huge increase in numbers and costs for spine surgery, the evidence shows this has been a waste.

In 2010, researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers' Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in the hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.³⁹

After two years, only 26 percent of those who had surgery returned to work compared to 67 percent of patients who did not have surgery. Of the lumbar fusion subjects, 36 percent had complications and the reoperation rate was 27 percent for surgical patients. Permanent disability rates were 11 percent for cases and 2 percent for nonoperative controls. In what might be the most troubling finding, researchers determined that there was a 41 percent increase in the use of painkillers, with 76 percent of cases continuing opioid use after surgery. Seventeen surgical patients died by the end of the study.⁴⁰

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