Nearly every week, I am told about someone who had surgical procedures to ease awful chronic back problems and found themselves far worse off than before the surgery. Among the list of greatest concerns is that money provokes surgeons to talk people into much larger and more complex treatments than they really need — and then those surgical procedures result in predictable complications.

The greed accusation sounds a bit tough, but it comes from a respected source: The Journal of the American Medical Association, in an editorial by a leading Stanford orthopedic surgeon, Eugene Carragee, and in a study carried out by a group of medical professionals at Oregon Health and Science University led by Dr. Richard Deyo.

The Oregon research observed that the rate of sophisticated surgical procedures for back ache in Medicare people jumped by 15-fold over a recent five-year period, but there was next to nothing in the patient population — like increasingly complex back deformities — to justify the increase.

Surgical service fees for simple decompressions are in the ball park of $600 to $1,000. The difficult surgical treatments make surgical professionals around 10 times more. Yet another possible component is the temptation for both medical doctors and individuals to go for a new, more expensive strategy simply because it sounds better.

The trouble is that the more elaborate surgical procedures carry at least double the danger of a bad outcome, according to the analysis.

Nearly all back pain that isn’t cured successfully with medicines or other non-surgical solutions is caused by disk herniation or spinal stenosis. Spinal stenosis is development of bone near a nerve coming out of the spinal cord which pushes on the nerve root and creates ache to radiate down a leg. The great majority of patients who need back surgery because of spinal stenosis can be benefited from a relatively simple lumbar decompression. This will involve removing bone, ligament and facet joint material which is compressing the nerve root. This surgery has a high level of success as it’s been established over the last 20 years.

According to one editorial, if the person also has some deformity of the spine — front to back or side to side — the simple lumbar decompression can bring about spine instability with elevated deformity, so those individuals might require a fusion where by adjacent vertebrae are fixed together with bone grafts. Even in these circumstances, simpler strategies get just as good results than more elaborate methods that add metal or other instrumentation into the back.

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