Avoidable Spine Surgeries: A Call for Conservative Approaches and Major Healthcare Savings

Executive Summary

As the U.S healthcare industry grapples with surging costs, it's becoming increasingly clear that a significant number of spine surgeries could be avoidable. A proactive, conservative approach such as physical therapy can serve as a viable alternative, providing similar outcomes while significantly reducing costs. By diverting 1,000 unnecessary surgeries to physical therapy per month, Luna Physical Therapy anticipates savings of at least $1.8 billion over five years, reducing hospital visits, and improving patient quality of life.

The Problem

Spine surgeries, while potentially life-changing in some instances, can range from $20,000 to $150,000 in cost, placing a heavy financial burden on both the healthcare system and patients. Compounding the problem is the fact that 15% of patients visit the emergency department post-surgery, with 99% of such cases being manageable in a doctor’s office. Additionally, 5-10% of patients are found to be readmitted to the hospital after surgery due to infection or complication.

Current projections forecast a 43% increase in these surgeries between now and 2030. 

Proposed Solution

Conservative approaches such as at-home physical therapy therapy offer a cost-effective and safer alternative to surgery for many patients. It assists in managing spinal pain, enhancing mobility, and can potentially delay or eliminate the need for surgery, thereby alleviating the significant financial burden on the healthcare system and improving patient outcomes.

The cost of physical therapy is significantly lower than the cost of surgery. With our proposed shift of 1,000 surgeries per month to at-home physical therapy, we predict a substantial $1.8 billion reduction or more in healthcare costs over five years.

Evidence Supporting Conservative Approaches Over Surgery

A wealth of research supports the notion of avoidable spine surgeries. For instance, it's suggested that as much as 90% of spine surgeries may be unnecessary, and even the most conservative estimate from another study points to at least 17.2% being avoidable. Yet other studies suggest approximately 50% of spine surgeries are avoidable.

Scholarly articles such as Harris et al., 2018 and Weiner et al., 2013 indicate that surgery is sometimes overused and that there is a lack of robust evidence supporting the effectiveness of many commonly performed spine surgeries. Other papers emphasize that certain types of minimally invasive surgeries may actually cause more nerve root injuries (Epstein, 2013) and that many surgeries for low back pain may lack strong evidence supporting their use (Chou et al., 2009).

Quality of Life Considerations and Convenience

Non-surgical approaches not only help prevent the risks associated with invasive surgeries but also enhance patients' quality of life. Without the need for significant recovery periods, these methods can increase patients' physical functionality and self-reliance. Physical therapy can be administered at home, offering convenience for patients and ensuring adherence to care.

Conclusion

Considering the financial savings, the improvement in patient quality of life, and the significant reduction in staggering costs, there is a compelling case for adopting conservative, non-surgical approaches as primary interventions for spinal issues. The focus should be on improving patient outcomes while simultaneously reducing healthcare costs and potential overutilization of invasive procedures.

Key References:

1. "Unnecessary" Spinal Surgery: A Prospective 1-Year Study. 2011.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130462/

2. Miller-Wagner, Are Many Spinal Surgeries Unnecessary?. https://www.miller-wagner.com/articles/are-many-spinal-surgeries-unnecessary/

3. 30k Unnecessary Spine Surgeries Performed in 1st Year of Pandemic. https://www.beckersspine.com/spine/54371-30k-unnecessary-spine-surgeries-performed-in-1st-year-of-pandemic-study.html

4. Walmart's Musculoskeletal Centers of Excellence Program: First-Year Results. https://www.catalyze.org/unnecessary-surgery-inappropriate-care/

5. Medical Mystery: Why Is Back Surgery So Popular in Casper, Wyo?. 2017. https://www.nytimes.com/2017/02/13/upshot/medical-mystery-why-is-back-surgery-so-popular-in-casper-wyo.html

6. Weiner, B. K., et al. (2013). Spine surgery in workers' compensation recipients: is it over-utilized?. *Spine*, 38(18), E1128-E1134. 

7. Harris, I. A., et al. (2018). Lumbar spine fusion: what is the evidence?. *Internal Medicine Journal*, 48(12), 1430-1434.

8. Epstein, N. E. (2013). More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review. *Surgical Neurology International*, 4(Suppl 5), S353.

9. Chou, R., et al. (2009). Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. *Spine*, 34(10), 1094-1109.

10. Deyo, R. A., et al. (2012). Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. *JAMA*, 307(13), 1378-1385.

11. Alvin, M. D., & Qureshi, S. (2014). The overuse of diagnostic imaging in the setting of primary low back pain. *Journal of back and musculoskeletal rehabilitation*, 27(3), 297-302.

12. Turner, J. A., et al. (1992). The importance of placebo effects in pain treatment and research. *JAMA*, 270(16), 1609-1614.