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Thursday, June 18, 2009

Who's Got Your Back? Bend Surgeons Do

Got an aching back? If you live in Bend, you're more than twice as likely to have surgery for it as the average American is.

Posted By on Thu, Jun 18, 2009 at 10:23 AM

Got an aching back? If you live in Bend, you're more than twice as likely to have surgery for it as the average American is.


That's the rather startling statistic unearthed by The Bulletin, which published a story this morning addressing the question of why so many back surgeries are done here. According to Medicare records, about 10 out of every 1,000 Bend enrollees receive back surgery - more than double the national rate. Among all American cities, we're Number Two in back surgeries; only Casper, WY does more per capita.

The reason is hard to pin down. There doesn't seem to be any basis for assuming that our backs are in horrendously worse shape than those of other Americans.

One factor that does seem to correlate with our high rate of back surgeries is our high number of spine surgeons. According to the American Association for Neurological Surgeons, writes Bulletin reporter Betsy Q. Cliff, nationwide there's roughly one neurosurgeon for every 86,000 people. In the three counties of Central Oregon there are seven doctors who do back surgery, or approximately one for every 29,000 residents.

More surgeons = more surgeries. It seems pretty logical.

Of course all the local surgeons interviewed by The Bulletin insisted they do back operations only when necessary. But "when necessary" is a judgment call, and a surgeon's judgment can conceivably be influenced by factors other than a patient's welfare - such as the need to pay his mortgage.

Unnecessary back surgery has been a problem in American medicine generally for decades. Way back in 1994, the federal Agency for Health Care Policy and Research did a study that found most back surgeries were unnecessary. (An organization of spine surgeons responded by trying to get Congress to kill the agency.)

An article in the current issue of AARP Magazine states that surgery isn't needed for the vast majority of back pains: "According to the American Association of Neurological Surgeons, 90 percent of herniated discs can be effectively treated with conservative therapies such as limited bed rest, exercise, and anti-inflammatory medications" such as ibuprofen or naproxen.

And in 2006, a study published in the Journal of the American Medical Association found that patients with sciatica - pain in the lower back, hip and leg caused by a ruptured spinal disc - recovered about equally well whether they had surgery or conservative treatment in the form of physical therapy, counseling and anti-inflammatory drugs.

The Bulletin story reports that a committee made up of St. Charles Medical Center medical staff and employees is trying to find out why we have such a high rate of back surgeries. Hopefully they'll get some solid answers.

Meanwhile, if your back hurts and you're thinking about going under the knife, you might want to try popping a few ibuprofens first.

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