Scam-orthopedic spine surgery?

[surag]

First, I'm a lowly premed who's starting osteopathy school next fall.

I researched some on orthopedic spine survey because of their high salary listing and found a lot of doctors participating in unethical practices. It's not just the lawsuits which are present in every specialty. It's also the ridiculousness of some of it. Respected doctors like vaccaro at Jefferson making 10-20 million a year in "royalties" which are argued (extensively) that they are kickbacks from medtronic seem to be the case for a lot of doctors. The wsj article mentioned at least 10. In other articles places like the laser spine institute doing really dangerous work to charge for rubbish operations. In Texas a guy sued 80 times to do awful procedures.

In all of these the common theme is hardware placement and disc fusing. For example the Texas guy removed multiple discs to replace with hardware-something no one should do apparently and made millions. All these guys have expensive lifestyles.

Also, the fusions are largely questioned. That there maybe no need for them in something like 90% of cases with disc issues (only to be used in extreme scoliosis cases etc). That the outcomes are no better than not doing the surgery.
I haveno doubt other doctors do such things such as the recent cardiologist.

But is this how most of spine surgery is? What I want to know is, can I become one and do other operations? Operations that pay well. The median is 800k or something. Is this accomplished by not doing the above? What operations does a spine surgeon do that are known to provide NECESSARY benefits etc as opposed to nonsurgery etc? Can one make a good living without resorting to these extreme activities? Are fusions the only reason for their financial windfall?

I'm not a troll. Just a bit jaded and also ignorant about what these folks do and the value of a good spinal surgeon. Both in terms of income and actually helping patients.

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[skiz knot]

First, I'm a lowly premed who's starting osteopathy school next fall.

I researched some on orthopedic spine survey because of their high salary listing and found a lot of doctors participating in unethical practices. It's not just the lawsuits which are present in every specialty. It's also the ridiculousness of some of it. Respected doctors like vaccaro at Jefferson making 10-20 million a year in "royalties" which are argued (extensively) that they are kickbacks from medtronic seem to be the case for a lot of doctors. The wsj article mentioned at least 10. In other articles places like the laser spine institute doing really dangerous work to charge for rubbish operations. In Texas a guy sued 80 times to do awful procedures.

In all of these the common theme is hardware placement and disc fusing. For example the Texas guy removed multiple discs to replace with hardware-something no one should do apparently and made millions. All these guys have expensive lifestyles.

Also, the fusions are largely questioned. That there maybe no need for them in something like 90% of cases with disc issues (only to be used in extreme scoliosis cases etc). That the outcomes are no better than not doing the surgery.
I haveno doubt other doctors do such things such as the recent cardiologist.

But is this how most of spine surgery is? What I want to know is, can I become one and do other operations? Operations that pay well. The median is 800k or something. Is this accomplished by not doing the above? What operations does a spine surgeon do that are known to provide NECESSARY benefits etc as opposed to nonsurgery etc? Can one make a good living without resorting to these extreme activities? Are fusions the only reason for their financial windfall?

I'm not a troll. Just a bit jaded and also ignorant about what these folks do and the value of a good spinal surgeon. Both in terms of income and actually helping patients.

Despite your poor grammar making your post barely readable, it is obvious that you are completely ignorant regarding what spine surgeons do, and why they do it, as is most of the public. Spinal fusion is helpful/necessary in more than just the "extreme scoliosis" patient. There are many degenerative and traumatic conditions necessitating fusion. Non surgical management is often not sufficient for severe stenosis from an unstable spondylolistheis or degenerative scoliosis, as well as a wide variety of other conditions. If you understood the biomechanics of the spine, you would realize that you can't just decompress in every case and continue to have a stable spine, necessitating fusion.

There are sure to be spine surgeons doing fusions for questionable indications, just as there are family practice physicians over billing for office visits, and unscrupulous characters in every other field of medicine (not to mention non-medical fields), but to imply (as the WSJ article does) that the surgeons mentioned perform these surgeries solely for the paycheck is slanderous, especially in light of the fact that you do not know anything about them. Through personal experience with some of the mentioned physicians in the article, I know that they are actually quite conservative in their recommendations for surgery, and only offer surgical intervention after non-operative management has failed. They do not perform fusions for back pain or "disk issues" because they know it will not likely be a benefit to the patient. There are patients with back pain and "disk issues" that do get fused, but these are co-diagnoses and there are other reasons necessitating the fusion. Plus they do not all lead "expensive lifestyles."

For you to call out the physicians receiving money for their consulting work is ridiculous, as you know nothing about them. They DO NOT receive "kick-backs" for implanting devices from certain manufacturers. However, some of the spine physicians mentioned in the WSJ article get paid royalties for designing the most widely used spinal instrumentation system, a multi-billion dollar industry. It seems you are suggesting they shouldn't be compensated for developing it.

P.S. Read the SPORT trial paper.

 

[Golding]

In fairness, part of the problem is indeed that you are a "lowly" premed trying to judge the ethics of a profession off a WSJ article. It's good to have a skeptical, but open, mind about certain professions. But you'll understand in the future that things aren't as black-and-white as critics will make them seem.

 

[surag]

In fairness, part of the problem is indeed that you are a "lowly" premed trying to judge the ethics of a profession off a WSJ article. It's good to have a skeptical, but open, mind about certain professions. But you'll understand in the future that things aren't as black-and-white as critics will make them seem.

Understood, but no one seems to be interested in discussing the other important operations Spine surgeons do. I'd like more information on this-something I havnt found anywhere else. You're a medical student-do you understand a lot more?

Skiz knot or whatever is full of blather and repetitive nonsense.

First off, I made it clear I was ignorant about a lot of issues. Yet he spent several sentences repeating this for no reason when I made it clear about my limited knowledge.

Then he goes off discussing how good these surgeons are without bothering to explain the controversy. He claims they received "royalties" when in reality these "royalties" were considered kickbacks by a plethora of spine surgeons at leading institutions. I'm sure these naysayers are happily well compensated and aren't making these statements in anger or jealousy. The royalties were devised this way so that a legal challenge could not be made. Do you really think companies would provide blatant kickbacks when they know they could be caught? Give me a break.

Finally, whats there for me to "understand?" in some of these situations? I mentioned other cases outside the WSJ article including spine surgeons who were caught for purposeful negligence in California (and finally jailed), in Texas (lost license) and in Florida. All of them had a commonality-they operated a high number of fusions with a lot of "hardware." These words, like hardware, that I use are based off reading the various articles not my attempt to sound knowledgeable of the situation. In many of these articles, many doctors assert that only in very very few cases should such operations be made (and none should use minimally invasive because of a lack of research-their words, not my assessment).

What I wanted to know and I will reiterate is, what other operations do spine doctors do? and is it possible to make the median average (800k) with these sorts of operations?

finally i apologize for my poor grammar. I'm typing from an IPhone...not exactly conducive to proper grammar or avoiding typos.

 

[Sam212]

Understood, but no one seems to be interested in discussing the other important operations Spine surgeons do. I'd like more information on this-something I havnt found anywhere else. You're a medical student-do you understand a lot more?

Skiz knot or whatever is full of blather and repetitive nonsense.

First off, I made it clear I was ignorant about a lot of issues. Yet he spent several sentences repeating this for no reason when I made it clear about my limited knowledge.

Then he goes off discussing how good these surgeons are without bothering to explain the controversy. He claims they received "royalties" when in reality these "royalties" were considered kickbacks by a plethora of spine surgeons at leading institutions. I'm sure these naysayers are happily well compensated and aren't making these statements in anger or jealousy. The royalties were devised this way so that a legal challenge could not be made. Do you really think companies would provide blatant kickbacks when they know they could be caught? Give me a break.

Finally, whats there for me to "understand?" in some of these situations? I mentioned other cases outside the WSJ article including spine surgeons who were caught for purposeful negligence in California (and finally jailed), in Texas (lost license) and in Florida. All of them had a commonality-they operated a high number of fusions with a lot of "hardware." These words, like hardware, that I use are based off reading the various articles not my attempt to sound knowledgeable of the situation. In many of these articles, many doctors assert that only in very very few cases should such operations be made (and none should use minimally invasive because of a lack of research-their words, not my assessment).

What I wanted to know and I will reiterate is, what other operations do spine doctors do? and is it possible to make the median average (800k) with these sorts of operations?

finally i apologize for my poor grammar. I'm typing from an IPhone...not exactly conducive to proper grammar or avoiding typos.

Bro, you blow a lot of smoke for someone who's just a lowly premed. I have seen you stir the pot in DO surgical residencies thread too. I understand that much of it is due to your curiosity and is well intentioned, but please understand that there are others who have been in trenches and know far more than you at this point.

 

[surag]

Bro, you blow a lot of smoke for someone who's just a lowly premed. I have seen you stir the pot in DO surgical residencies thread too. I understand that much of it is due to your curiosity and is well intentioned, but please understand that there are others who have been in trenches and know far more than you at this point.

So if I read something that is factual and report it-ie other spine surgeon's comments that are publicly available then I am wrong for it? I'm not asserting myself, I'm presenting what I see elsewhere. I make it clear I dont know much and I ask people to help explain what other procedures spine surgeons do and no one bothers tomention it??!!

 

[Golding]

Understood, but no one seems to be interested in discussing the other important operations Spine surgeons do. I'd like more information on this-something I havnt found anywhere else. You're a medical student-do you understand a lot more?

I don't want to give the misconception that I think I know it all. Indeed, I'm at the end of medical school and have plenty to learn. But I think that with what experience I have, it's plenty possible to see through some of the misconceptions presented. At least, that is, without any links provided to the article. Among them: Damning an entire profession for minority examples, citing "arguable" kickbacks (which is a politically charged word these days) without much backstory, and broadly condemning a case that we have no real specifics about to judge one way or another.

The more glaring issue is that you suggest, per this WSJ article, that "the fusions" are an unnecessary procedure. Fusions are a widely varied group of procedures that are difficult to realistically lump into one category, suggest they have a single indication, and condemn their use. There are anterior and posterior spinal fusions, lumbar and cervical fusions, each with their proper indications and contraindications.

Skiz knot or whatever is full of blather and repetitive nonsense.

First off, I made it clear I was ignorant about a lot of issues. Yet he spent several sentences repeating this for no reason when I made it clear about my limited knowledge.

Then he goes off discussing how good these surgeons are without bothering to explain the controversy. He claims they received "royalties" when in reality these "royalties" were considered kickbacks by a plethora of spine surgeons at leading institutions. I'm sure these naysayers are happily well compensated and aren't making these statements in anger or jealousy. The royalties were devised this way so that a legal challenge could not be made. Do you really think companies would provide blatant kickbacks when they know they could be caught? Give me a break.

Totally fair, but again I simply wouldn't feel comfortable casting judgment on alleged kickbacks without really knowing the story. I also contend that the potential misbehavior of one doctor doesn't condemn an entire field. I'd be perfectly willing to read about the story if you provide the article, or even more specific detail to the circumstances.

Finally, whats there for me to "understand?" in some of these situations? I mentioned other cases outside the WSJ article including spine surgeons who were caught for purposeful negligence in California (and finally jailed), in Texas (lost license) and in Florida. All of them had a commonality-they operated a high number of fusions with a lot of "hardware." These words, like hardware, that I use are based off reading the various articles not my attempt to sound knowledgeable of the situation. In many of these articles, many doctors assert that only in very very few cases should such operations be made (and none should use minimally invasive because of a lack of research-their words, not my assessment).

I think you'll understand in the future that medicine is not as black-and-white as legal teams try to make it seem. The reality is that there are gray areas where benefits and costs closely align, and the argument for certain procedures can be reasonably made in either direction.

Again, I'd prefer to see the cited articles. I think you're jumping to a conclusion by asserting that three doctors who did a lot of fusions were found to be negligent. What were they found negligent for, specifically? What did one of them lose their license for? Are they in the minority of surgeons who have high volumes, or are their colleagues (who are not losing their licenses) also taking on many cases? I think it might be worth looking into some of these things before going from point A to point D.

What I wanted to know and I will reiterate is, what other operations do spine doctors do? and is it possible to make the median average (800k) with these sorts of operations?

finally i apologize for my poor grammar. I'm typing from an IPhone...not exactly conducive to proper grammar or avoiding typos.

Other surgeries you'll see spine surgeons doing include discectomies, foramenotomies, laminectomies, spinal disc replacements, spinal canal decompression, decompression and stabilization of spinal tumors, X-STOP, among others. Whether they would continue to make a luxurious income in the absence of doing certain fusions ultimately depends on a variety of factors.

 

[kitsunepixie]

Other surgeries you'll see spine surgeons doing include discectomies, foramenotomies, laminectomies, spinal disc replacements, spinal canal decompression, decompression and stabilization of spinal tumors, X-STOP, among others. Whether they would continue to make a luxurious income in the absence of doing certain fusions ultimately depends on a variety of factors.

I'm a lowly neurosurgery resident at an institution in which the vast majority of spine cases go to us rather than Ortho (the exception being pediatric scoliosis). I can tell you that although we are extremely conservative on who we operate on for back/neck pathology, our clinics have long wait lists with patients with the above complaints who regularly harass our scheduling staff to get appointments to see us, and that our ORs are booked for MONTHS to perform the elective operations mentioned above by Golding.

Neck & back pain are among the most common complaints that patients go to their PCPs for, and the majority of those people are never operated on. There are some patients with chronic back and neck pain with no straightforward pathology to treat (straightforward being like an L5 radiculopathy that correlates on both MRI and clinical exam from a disc herniation or anterolisthesis, or cervical myelopathy from spinal stenosis) that fail conservative management (physical therapy, lifestyle modification, etc.) that our surgeons wouldn't touch with a 10-foot pole who are desperate enough to surgeon shop until they find someone who will operate on them. Those surgeons operate at their own risk, IMHO.

I'd say that you just need more exposure to the field of spine surgery before you write it all off. I wasn't too enthused about all the spine ahead of me in my neurosurgery training at first since, like yourself, I heard reports of spine surgeries being done on the wrong people for the wrong reasons, as well as the fact that dealing with back pain wasn't high on my list of what attracted me to neurosurgery...but I'm started to really enjoy it now. Seeing a myelopathic patient with a neurogenic bladder who can't walk because of a T10 meningioma regain most of the strength in her legs 10 minutes after waking her up after surgery was probably my most memorable case, but I've seen some great results on discectomy and ACDF patients with improvement in their radiculopathy as well.

 

[tanaya]

Spine surgery is rarely an initial treatment for back pain, however, there are a few emergencies that may require surgical treatment. In the vast majority of patients, spine surgery is only considered after a long course of conservative therapy. As stated earlier, back pain often takes quite some time to resolve. Therefore, rushing into spine surgery may not be the best idea. Most commonly, it is advisable at least 3 to 6 months of conservative treatment before considering spine surgery.
A discectomy is a procedure to remove a portion of the disc that rests between each vertebrae. A herniated disc is the most common reason for spine surgery. In this type of spine surgery, the herniated disc is removed and relieve the pressure on the nerves.
Foramenotomy
A foramenotomy is also a procedure used to relieve pressure on a nerve, but in this case, the nerve is being pinched by more than just herniated disc. A foramenotomy removes a portion of bone and other tissue that may be compressing the nerve as it exits the spinal column.

Laminectomy
A laminectomy is done to relieve pressure on the spinal cord itself. A laminectomy is most commonly used to treat conditions such as spinal stenosis and spondylolisthesis. Depending on the amount of bone removed, this procedure may be done with a spinal fusion to prevent instability.

A spine fusion is surgery that is done to eliminate motion between adjacent vertebrae. The spine fusion may be done because to treat a problem such as spondylolisthesis (unstable spine), or it may be done because of the extent of other surgery

http://www.arthroscopysurgeryindia.com/Articles.aspx?id=14