Nearly every week, I am told about someone who had surgery to reduce extreme chronic back problems and wound up with worse symptoms than before the surgery. Among the list of largest issues is that money provokes surgeons to convince people into much larger and more complicated surgical procedures than they really need — and then those surgical treatments lead to foreseen complications.

The greed accusation looks a bit severe, but it comes straight from the top: 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 physicians at Oregon Health and Science University led by Dr. Richard Deyo.

The Oregon study discovered that the rate of sophisticated surgeries for back discomfort in Medicare individuals increased by 15-fold over a recent five-year time period, but there was practically nothing in the patient population — like increasingly challenging back deformities — to explain the increase.

Surgical service fees for very simple decompressions are approximately $600 to $1,000. The sophisticated surgical procedures earn surgical professionals around 10 times more. Another probable component is the tendency for both doctors and patients to go for a new, more pricey approach simply because it sounds better.

The challenge is that the more sophisticated surgical procedures have at least double the chance of a undesirable outcome, according to the study.

The majority of back pain that isn’t cured effectively with medicines or other non-surgical treatments is a result of disk herniation or spinal stenosis. Spinal stenosis is growth of bone in the vicinity of a nerve coming out of the spinal cord which presses against the nerve root and brings about discomfort to move down a leg. The vast majority of people who need back surgery because of spinal stenosis can be benefited from a relatively simple lumbar decompression. This requires removing bone, ligament and facet joint material which is compressing the nerve root. This operation has a high rate of success as it’s been established over the last 20 years.

As outlined by one editorial, if the person also has some deformity of the spine — front to back or side to side — the simple lumbar decompression can cause spine instability with greater deformity, so those individuals might require a fusion in which adjacent vertebrae are fixed together with bone grafts. But even here, simpler methods get just as good results than more complicated methods that add metal or other instrumentation into the back.

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