BEWARE of "BIG SURGERY!"
You’ve no doubt heard of “Big Oil,” “Big Tech,” and “Big Government,” but have you heard of “Big Surgery?” I didn’t think so. Although it exists like the other “Bigs,” only a very select group of people know about Big Surgery. Who are they? They’re people like me whose initial spinal fusion surgery turned into two, three, four, or more additional surgeries. In fact, of the hundreds of thousands of patients who have spinal fusion surgery each year in the United State, four out of ten to seven out of ten (40% to 70%) experience failed surgeries, requiring one or more additional “salvage” or “revision” surgeries to correct. And speaking from experience, these patients would do almost anything to not be in that select group.
So, “What does all this have to do with Big Surgery?” you may be wondering. Well, here’s the skinny. There’s a cabal comprised of Spine Surgeons, Hospitals, and Medical Device Manufacturers that work individually and loosely together to promote spine fusion surgery as the best, most effective treatment for chronic spine pain. Why do they do this? Moola. Cabbage. Money, of course!
Let’s take a deeper look at the individual members of the cabal that together form “Big Surgery.”
SURGEONS:
According to Glassdoor.com, the estimated total pay for a spine surgeon in America is $210,151.00 per year. That’s a lot of cabbage, isn’t it? But some spine surgeons earn much more, with the highest salary being $326,921.00 per year! If you don’t think these figures are correct, tell me the last time you saw a neurosurgeon driving a 12-year-old Chevy. No way, no how! (mine drove a Porsche, which after my three spine surgeries in three years by the same surgeon, I’m sure I paid for!)
HOSPITALS:
Did you know that spine fusion surgeries are one of the biggest revenue sources for most hospitals? Don’t believe me? The average fee for a spinal fusion surgery hospital in Florida is over $111,662.00 (in 2012 dollars), which doesn’t include the costs of surgeons and other doctors. And that’s just one state! Keeping their operating rooms constantly occupied is a big incentive for encouraging surgeons to do more spine surgeries. (not that they would ever think this!) Lest you think I’m overstating the case, let’s look at the data. According to iData Research, in the United States, there are approximately 1.62 million instrumented spinal procedures performed annually. Granted, that’s not the total number of fusion surgeries since multiple procedures are done in a single surgery. Still, that’s a lot of spinal procedures, friends! I would do the math for you, but I would have to take my shoes off, and it’s too cold today, but you should have a pretty good idea of how profitable spine surgery is for hospitals.
MEDICAL DEVICE MANUFACTURERS:
Last but not least, what about the medical device makers? Don’t worry! These little piggies haven’t been nudged away from the feeding trough. Big medical device companies like Medtronic, De Puy Synthes, NuVasive, and others who make the titanium rods, screws, and specialty tools and technologies that surgeons use in spinal fusion surgery, are growing fatter by the day.
The market size for spinal fusion surgery devices accounted for $6.54 billion in 2022 and is expected to be $10.7 billion by 2032.
Now you know why I call the Surgeons, Hospitals, and Device Makers Big Surgery. When billions upon billions of dollars are at stake each year, there’s a lot of incentive to help people suffering from chronic back pain think that spinal fusion surgery is the magic cure they are looking for so they can get their signature on the dotted line. But while most ethical spine surgeons will tell you at least some of the downsides of the spine fusion surgery story, they, like their other Big Surgery buddies, probably won’t go out of their way to share the whole story with you. Here’s the other part of their story.
Every time some poor sucker “goes under the knife” thinking, just before the anesthesiologist put their lights out, that when they wake up, their spine pain will be magically gone, the cash register rings at Big Surgery headquarters. But do you know what happens to many of those patients after their surgery? When the unicorns and rainbows disappear from their clouded brains as they awaken in the recovery room, they find themselves either in the same pain as before surgery or, like far too many other victims of Big Surgery, they’ll discover they have increased pain, and in more places, than before their surgery. And as a bonus, it’s also a good bet that their pain is now permanent due to scar tissue and nerve damage! (make room for the pain management doctors at the trough!)
If you don’t believe this story is true, take the “Big Surgery Challenge.” Go to any spine surgeon’s, hospital’s, or device maker’s websites and see if you can find their spine surgery success rates. (or conversely, their failure rates) You won’t, but you will find somewhere in the fine print, down deep in their websites, some short statements about how risky spine surgery can be, but they will be very general and very short and probably written by their attorneys. But I guarantee that they won’t tell you all of the facts because if they did, “Big Surgery” would become “Small Surgery,” and their friendly Porsche dealer just might go out of business!
THE FACTS ABOUT SPINE SURGERY:
As a chronic back pain patient, you would be forgiven if you think that because there are so many spine surgeries taking place each year, they must be effective at resolving pain from spine problems, right? Nope! In fact, it’s widely known (at least by “Big Surgery”) that these fusions often fail, especially for those patients over 65 years old or patients with other health issues, where failure rates are much higher than for the general adult population.
Following are a few troubling statistics regarding spinal fusion surgery from my books, ”Back Surgery for Beginners” and “War on Chronic Pain.”
Recent statistics show that, depending on the type of spine surgery, failure rates can range from a low of 15 percent to upwards of 70 percent, or more, of all spine surgeries, with fusion surgeries accounting for the largest percentages of those failures!
Once you have your first surgery, studies show that from fifteen months to twenty-four months (or longer) after an instrumented fusion for the treatment of Failed Back Surgery Syndrome (FBSS), the success rate was only 35%, meaning that 65% of those surgeries failed in some aspect! Put another way, two-thirds or two out of every three spinal fusion surgery patients require additional revision surgeries and are left in greater pain than before their initial surgery.
80% of Americans will experience back pain at some point in their lives.
Back pain is the second most popular reason for seeing a general practitioner.
Spinal fusion surgeries have more than doubled since 2000 and are increasing rapidly each year.
People over 65 experience more spine pain and spinal symptoms than younger patients, and this age group is growing annually.
The average cost of a spinal fusion surgery hospital fee in Florida is over $111,662.00 (in 2012 dollars), which doesn’t include the costs of surgeons and other doctors.
Studies show that 40 percent or more of scoliosis surgeries require one or more revision or salvage surgeries.
Each year more than 450,000 back fusion surgeries in the US generate from six ($6B) to thirty-three ($33B) billion dollars (2012 data), depending on the research study.
Studies indicate that 75 percent or more of back surgeries may fail to deliver anticipated positive results.
THE CABAL:
According to Dictionary.com, a “cabal” is a:
noun
a small group of secret plotters, as against a government or person in authority.
the plots and schemes of such a group; intrigue.
While the data about the surgeons, hospitals, and medical device makers, when taken separately, is important to know, it’s the implied ‘cabal’ that worries me. There seems to be, at best, alliances among the three Big Surgery players that conspire to keep the truth about their industry’s failures a secret from the patients that keep them in Champagne and caviar.
For instance, I discovered during my due diligence in attempting to bring suit against my surgeons and the makers of my titanium rods and screws that failed me three times that there appear to be shady connections between surgeons and the device makers whose hardware they select to implant in their patient’s spines. Now, I don’t think this is payola, but I discovered that surgeons regularly go on junkets to exotic vacation locales around the world that are paid for in full or in part by the device makers that you’ve already read about. The way it works is that surgeons are paid “honorariums” for speaking at these meetings, and for doing that work, they receive a reimbursement for their expenses and perhaps a per-diem to offset their food and airfares. While these get-togethers may be legal, there’s certainly a lot of influence peddling going on. Say you are a surgeon and you just came home from a ten-day “meeting” in Fiji (is Chicago in winter not exotic enough for you?) where you presented a paper, gave a speech, or sat in on a discussion panel. Whose devices do you think the surgeon will specify when he arrives in your operating room after returning to work with a great tan and a big smile? (Obviously, in my case, somebody didn’t get invited to Fiji, and, as a result, my surgeon didn’t go with the highest quality supplier. How else can you explain my titanium rods breaking three times in a row?)
Another way the device makers woo surgeons is by making them “Consulting Surgeons” or “Development Partners” for their companies. I would think that once a surgeon is on the payroll, jumping ship to use another device maker that conceivably has better technologies or product quality would be difficult unless they were willing to “up the ante.” Surgeons should make any potential conflicts of interest with device makers and any hospital affiliations known to their prospective patients. Period.
Hospitals don’t get away scot-free either. It’s a fact that surgeons often maintain very close ties to a particular hospital for their surgeries. In fact, they often maintain their offices on the same hospital campuses within easy walking distance. They bring a lot of business and revenue to those hospitals, so you have to wonder why they chose that particular hospital. It may be nothing untoward going on in these cases, but I’d bet that there are “honorariums” of some type going on here as well.
While I’m not making accusations, and I believe (hope) that most surgeons always act ethically with their patient’s best interest at heart, it’s pretty easy to think that this is not always the case given the practices of the medical/surgical complex that I’ve outlined here. I definitely think that every patient should be aware of these potential connections when choosing a surgeon or hospital, no matter how “loose” or innocent those connections may be.
I would have much more confidence in Big Surgery if all of the players presented the real facts about the effectiveness, failure rates, and risk factors of spine surgery and their products and services out in the open on their websites, in easy-to-understand layman’s language, and in full view of prospective patients. They should add the same information in all of their sales literature and in their initial consultations with their would-be patients. Then, at least, patients could make well-informed decisions about one of the biggest, most impactful medical decisions, not to mention life decisions they may ever have to make. They have the information; they just need to expose it, and patients need to demand it before making any decisions on a prospective surgery.
A PARTING SUMMARY:
Depressing, isn’t it? Yes, it is, as I can personally attest to since my first spinal fusion surgery turned into four additional surgeries, three of them back-to-back in less than two years. OK, I admit that I’m biased against “Big Surgery,” but I think the data speak for themselves. So, here comes the Big Takeaway if you haven’t surmised it by now.
DON’T MESS AROUND WITH BIG SURGERY! You may not like the outcome! But seriously, if you suffer from chronic back pain, please don’t choose spine fusion surgery if you believe it will cure your pain! Chances are that it won’t. Besides, there are dozens of much safer, far less risky alternative treatment solutions available that will likely help reduce or eliminate your pain. Spine surgery should be the absolute last treatment option you should choose, and then, they should have to drag you kicking and screaming into the operating room! One more piece of advice from an old pain warrior, if surgery is called for, make sure it is the smallest surgery you can get by with. The more levels that are fused, the higher your chance of regretting your decision to undergo spinal fusion surgery.
Please Share “Big Surgery” with Others
If more people knew the truth about Big Surgery, there would be many fewer chronic spine pain sufferers living out their lives in intractable pain and with unending regrets. Believe me; I know all too well that a failed spine fusion surgery can generate a ton of regrets and increased pain.
If you suffer from chronic back pain, I hope you found some value in reading this post and that the information you’ve read about will help you kick-start your own due diligence to discover the best non-surgical treatment options for your pain. To help you get started, here’s my gift to you. Click the link below to download a free copy of my latest book for chronic back pain sufferers, “Back Pain for Beginners.”
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All the Best!
Franklin
P.S. - By the way, if you were wondering, I failed in my efforts to bring suit against my surgeons and the device maker that made the rods and screws they used in my back. It failed due to the very short time limit to file suit in North Carolina (one year) and because I couldn’t find a single law firm in the entire state that would take on a suit against any of the Big Surgery players, which is understandable when one side has billions of dollars with which to defend themselves.