Check out this video from Dr Eric Bricker. In New York, there are 2.5 spine surgeries per thousand patients. In Dallas the rate is 4.9 per thousand and in Denton County in the same metro area is at 8.8 per thousand. If you are in Denton County you are over three times more likely to have spine surgery compared with people who live in New York or San Francisco. Is that because there are more spine problems in Texas. No! It is because surgeons in Texas are more aggressive and willing to operate on more people. Why? One spine operation can cost $80,000. Follow the money.
My understanding is that spine surgery provides benefit in only about 50% of patients. The Walmart center of excellence program for spine surgery finds that 54% who are referred to a center of excellence for spine surgery don’t need it due to better treatment options — or because surgery wouldn’t fix their problem. My friends at Integrated Mechanical Care tell me that the diagnosis is frequently in error, and I am a witness. My wife has such horrible back pain that there have been times that movement caused her to cry out. I am an internist who has decades of experience. We tried everything. She saw orthopedists who thought it was her sacroiliac joint. A steroid shot was no help. She was seen in pain management. She had spinal canal steroid shots. No help. She had a small disc bulge on MRI that no one thought was causing her problem. She saw a rheumatologist.
Finally, in sheer desperation, we tried to find a physiatrist. "Physiatry combines physical therapy and pain treatments to help patients avoid surgery." Oddly enough, the physiatrist was embedded in a practice with spine surgeons. I called to make an appointment with a physiatrist. I was told, "You can't make an appointment with a physiatrist without seeing a spine surgeon first to be sure you are not in urgent danger. If you are cleared by the spine surgeon, then you can see the physiatrist." That should have been a flashing red light for me, but I missed it.
The physiatrist should be able to sort out who is at risk. I am highly confident that physical therapists trained in the McKenzie method can do it. Their first decision is this. Is the condition a "green light" condition that will respond to PT or is it a red light condition that requires an MRI and referral for surgical consideration. They are very good at that. But as I said, I missed it, and we made an appointment with the spine surgeon. The new patient visit was thorough. He listened to the history of the beginning and progression of symptoms. He looked at the images. He did a thorough examination. When he was finished, he did not say "You can see the physiatrist." He said that we could have a facet injection, OR he could do surgery. “I will do surgery on your spine from the back side, and then we will flip you over and do an abdominal incision. We will apply hardware to the front of your spine and stabilize it.” Right then and there, I knew the surgeon's logic was deeply flawed. Even if he was on the right track, the right answer would be to do the minimally invasive facet injection first, see if that helps, and if not, then recommend spine surgery. I knew it instantly and as my wife and I were leaving I told her "We are never coming back here." and I explained why. We never got to see the physiatrist.
As it turned out, my wife did not need back surgery at all. She was finally diagnosed with a very rare autoimmune disease known as relapsing polychondritis. Most rheumatologists have only seen a few cases. The third rheumatologist she saw confirmed the diagnosis. She had spells where she felt like she had the flu for 4 days and then she would get better for 4 days. These people make antibodies against their own cartilage and until recently they died of suffocation from airway collapse. She was in danger, but not from her spine. Spine surgery would have been a miserable experience with absolutely no gain in a woman who had pain from a completely unrelated cause. I would never have spine surgery without a Mackenzie physical therapy evaluation first. As it turns out, the physiatrist may have protected us and other patients from this doctor. You may draw your own conclusions about the variation in spine surgery depending on where you live.
Dr. Steve Schutzer has come up with a great model in Connecticut. “At the orthopedic service line (Saint Francis Hospital and Trinity New England) we launched a non-surgical "comprehensive spine program" 6 years ago. The program was based on the fine work by Chad and Mark at IMC and employs the McKenzie technique as its core offering. Every patient is seen (at the same visit) by a physiatrist (employed) and a McKenzie trained PT. Our surgical conversion rate most recently was 1.4% (literature suggests it can range from 15 - 30%).” That is the model that can protect patients in your community.
I want to be clear. I owe my life to a good surgeon. It you have cancer like I had, you need surgery. If you are overweight, there are better answers than gastric bypass. It has been a long, hard road for my wife, but she is able to do more now.
Orthopedics mixed with hired physiatrists is a toxic brew of corruption. People need to be aware. Good story, Bill!