A complex operation called spinal fusion has emerged as the treatment of choice for many kinds of back pain. But a number of researchers say there is little scientific evidence to show that for most patients, spinal fusion works any better than a r operation, the lamineetomy (椎板切除术). Some people would be better off with no surgery at all. Even doctors who favor fusions say that more research is needed on their benefits.
In the absence of better data, critics point to a different reason for the fusion operation’s fast rise: money. Medicare can pay a surgeon as much as four times more for a spinal fusion as for a laminectomy. Hospitals also collect two to four times as much. "We all cave in to market and economic forces," said Dr. Edward C. Benzel. Though doctors, as a rule, should favor the least complicated treatment—with surgery being the last resort — Dr. Benzel estimated that fewer than half of the spinal fusions done today were probably appropriate.
Doctors and hospitals are not the only players with a financial stake in fusion operations. Critics blame the companies that make the hardware for promoting more complex fusions without evidence that they are significantly more effective. Some sort of hardware is used in almost 90 percent of lower-back fusions and the national bill for the hardware alone has soared to $ 2.5 billion a year.
The hardware makers acknowledge giving surgeons millions of dollars for consulting and researches, but say the money promotes technical and medical advances that improve back care. But a lawsuit brought by Scott A. Wiese, a former sales representative of Medtronic-the biggest maker of spinal hardware, accused the company of trying to persuade surgeons to use its products with offers of first-class plane tickets to Hawaii and nights at the finest hotels. Medtronic said it did nothing wrong, and it denied the accusations in the lawsuit. But the company disclosed earlier this year that the federal government was investigating charges that it paid illegal kickbacks to surgeons. Federal officials declined to comment on the investigation, and Medtronic said it would vigorously defend itself.
Still, between the allure of money and the quest for breakthroughs in treatment, some prominent spinal surgeons say that back care has gone astray.
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