Maine Study Challenges Major Assumptions About Spine Care
Very interesting article. The success of spinal surgery is higher in the areas of the country with the lowest rates of surgery. And, based on the facts that the rates of surgery vary widely across the country, and yet patient presentations do not, are many patients getting unnecessary and unsuccessful surgeries??
The Back Letter 14(12):133,140, 1999 When two surgeons in Boston and Paris perform disc surgery on similar patients using similar techniques, will the results be similar? What about two surgeons in Boston and New York? Or two surgeons in Maine? The answer may be surprising. One of the most provocative spine studies of 1999 didn’t get a lot of headlines. It didn’t offer new diagnostic technology or promise miracle cures. Yet the study challenges central assumptions about spine care and recommends major changes in the way specialists conduct their practices. The study found that patients in areas of Maine with higher surgery rates had inferior outcomes to patients in areas with lower surgery rates. The reason? It appeared that surgeons in the areas with lower surgical rates had more stringent selection criteria for spine surgery. Yet the surgeons in these areas did not appear to have any inkling that they were practising their specialty differently. “Before presentation of the results of the current study, surgeons in each of the three areas [of Maine] believed that they operated on patients with similar indications and that they produced similar outcomes,” according to Robert B. Keller et al.