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n the wake of Tiger Woods’s arrest on Memorial Day for driving under the influence, much attention has been paid to his drug use. The incident — wherein he was found asleep at the steering wheel while his car stood in the right lane — was, the golfer said, not the fault of alcohol but rather “an unexpected reaction to prescribed medications.”

But what’s been less discussed is the role of the back surgery Woods recently underwent, called spinal fusion. Woods had the surgery in April “to alleviate ongoing pain in his back and leg,” according to his website. (This was his fourth back surgery.)

According to the police report, one prescription Woods has is the opioid pain reliever Vicodin, possibly related to the back surgery — though Woods’s agent would not say if that was the reason, according to the Washington Post.

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But the incident points to a bigger problem with such surgeries: Spinal fusions are rising in prevalence even though they often don’t work, leave patients in pain, and can drive patients to long-term dependence on pain relievers.

Here are six things to know about spinal fusions and prescription medication.

1. Spinal fusions are increasingly common

Hundreds of thousands of Americans undergo this popular procedure every year to relieve back pain. Many receive prescription opioids afterwards. From 1998 to 2008, the number of spinal fusion surgeries more than doubled, from 174,223 to 413,171, according to a paper published in the journal Spine.

2. Many people become dependent on pain relievers after back surgery

Doctors are worried about the rising rate of opioid prescriptions for surgery-related lower back pain. The surgery is intended to relieve pain, but it’s also often associated with pain of its own.

In a paper published this year in Spine, researchers found that about 20 percent of patients who underwent lumbar fusion surgery continued to take opioids two years after the surgery.

“There is widespread concern about long-term opioid dependence among patients who undergo spinal fusion surgery,” researchers wrote. “Moreover, the efficacy of long-term opioid use for low back pain following spinal fusion surgery is widely debated.”

3. The surgery is often done when it’s not needed

There is a growing controversy about whether spinal fusions are necessary all of the time. Without knowing more about Woods’s medical conditions, it’s impossible to even ask that question of his surgery in particular.

Scientific studies have found that spinal fusion might not work any better than other, non-surgical interventions.

And in 2013 the Washington Post reviewed patient records in Florida, identifying thousands of cases of spinal surgeries being conducted in cases that experts might deem unnecessary.

4. As an alternative to surgery, opioids aren’t much better

The American College of Physicians’s guidelines on back pain, published in April, warned against using opioids to treat back pain — in part because there’s little evidence showing they work well, and in part because of their dangerous side effects.

“Opioids should be the last treatment option considered and should be considered only in patients for whom other therapies have failed because they are associated with substantial harms,” the group wrote, referring to patients with chronic low-back pain.

5. Doctors get paid big bucks to do these surgeries

The Washington Post noted that surgeons may be incentivized to perform costly fusion procedures when cheaper, simpler ones may suffice — because then the surgeon will be able to charge more. Spinal fusion can bring in $6,000, while a cheaper “decompression” surgery might only net $1,000.

6. But spinal fusion may not help people in the long run

If back surgery doesn’t help you get back to living a normal life, then what’s the point? A team of Ohio researchers tackled this question in a 2011 Spine paper in which they examined individuals who were injured at work. The findings did not bode well for the surgery.

“This procedure is offered to improve pain and function, yet objective outcomes showed increased permanent disability, poor [return-to-work] status, and higher doses of opioids,” the authors wrote.

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  • The study mentioned at the end of this article from Ohio was a study on workers comp patients. It been noted for better the 30 years that workers comp patient do much worse with any surgery performed on them. To use this study to as an example of spine surgery not being of benefit is incredibly misleading. When performed for the right reasons on the right patient, spinal fusions can return people to normal function, when they may not be able to even walk without severe pain prior to surgery.

  • Spinal fusion surgery gave me my life back, AND I rarely have to even take an over the counter pain medicine for it now. Maybe I’m just a minority though.

  • Spine Doctor is a funny guy. Comes off as scientific, but his opinions are about 10 years behind the science.

  • Yet another medical troll, Spine Doctor, raises his ugly head to lash out at SMT that has now been endorsed by a litany of medical guidelines including the ACP, JAMA, NASS, Joint Commission, FDA, to name a few recent ones.
    As well, there are many ethical MDs and neurosurgeons who comment on the rash of unnecessary spine surgeries.
    Nancy Epstein, neurosurgeon and editor at Surgical Neurology International (SNI), suggested, “Increasingly, patients, spine surgeons, hospitals, and insurance carriers should not only be questioning whether spinal operations are ‘unnecessary’, but also whether they are ‘wrong’ (e.g., overly extensive, anterior vs. posterior operations) or ‘right’ (appropriate).”
    • In 2013, Epstein and Hood concluded in their study, “Are recommended spine operations either unnecessary or too complex?”: Evidence from second opinions, that of 183 second opinions seen over 20 months, the second opinion surgeon documented that previous spine surgeons recommended “unnecessary” (60.7%), the “wrong” (33.3%) or the “right” (6%) operations. This study suggests 94.0% of cases were given unnecessary or wrong recommendations.
    The most troublesome aspect of this spine fusion ruse is the abundant research debunking “bad discs” as the sole cause of back pain and the need for surgery.
    Let me distinguished between validated fusion indications such as destabilizing spine problems, severe trauma, cancer, neurological catastrophe, and poorly validated ones such as DDD, disc herniation, simple spinal stenosis that constitute the majority of spine surgeries that lead to failed back surgery.
    Approximately 90% of LBP is primarily “mechanical” in nature–joint dysfunction, poor core strength, flexibility. Indeed, “bad discs” are secondary to the mechanical overload caused by structural misalignment and compression. A disc does not herniate on its own, only when forced by bad leverage, overloading, etc.
    In fact, DDD is now deemed by experts as a non-condition due to its high prevalence in pain-free people, but this misdiagnosis is kept alive by spine surgeons and the rest of the medical industrial complex because it is a huge money-maker.
    I urge readers to ignore Spine Doctor who obviously is misleading you with his bias and chirophobia. Also, why is he hiding behind a moniker and not revealing his/her real name–more deception–but that’s what trolls do!
    You might enjoy this article about the Mayo Clinic Review of “bad discs” @ http://chiropractorsforfairjournalism.com/-Bad_Discs__Dead__Again.html

  • Surgery often doesn’t work. Pain meds are bad. What’s left for sufferers of severe spinal damage or deterioration?

    • Each person’s back problem is different, but mine got much better with physical therapy and a lot of walking at short intervals. Before that, I was in severe pain. I couldn’t sleep very long or very much. The physical therapist gave me some exercises to do. And moving around in some way every few minutes helps a lot, even if it hurts a bit at the time. (If the pain is severe, perhaps it’s not the time to move, but it’s hard to convey the severity of pain.) Ice packs can help too, especially for sciatica.

      When the pain was still really bad, I would lie in the hammock for a while, then get up and walk half as far away as I thought I could get, and then back. A few minutes later, I’d do it again. At first, I think I got about 20 feet. The first day I made it around the block was wonderful. And then I got it up to several miles. Eventually, I could even sleep enough.

      In general, the way my back feels is a reflection of how much walking and exercising I’ve been doing, although I’ll admit there’s an emotional component as well.

  • Why wasn’t he taken to a Hospital?
    Since when a prescribed treatment side effects are handled ( or mishandled) by police as a criminal offense? And why??
    Do jails provide better medical treatment, or in this particular case, a better outcome?
    Should Physicians give punishment to traffic violations or similars?

    • Often police treat the results of physical failures: diabetes lows can turn diabetics into seeming drunks, heart failure and seizures can lead to accidents, etc. it’s not unheard of for police to jail those needing medical treatment–not out of malice, but out of ignorance.

  • I enjoyed this article immensely, but it left out one important point.
    As a 40-year chiropractor, I see many failed back surgery patients like Tiger who were mislead by their PCP into medical spine care–opioids, epidural steroid injections, and fusion surgery–and like him after four back surgeries, they are still hurting and clueless. The new ACP and JAMA guidelines, like the original 1994 AHCPR guideline, all recommend conservative hands-on care first; even those who have surgery rarely stay better, most relapse within a few years because the underlying problem is not a “bad disc” of some sort, but joint dysfunction, which explains why spinal manipulation, therapeutic massage, yoga, tai chi and self-care exercises have proven most effective by restoring joint play. Sadly, too many bigoted MDs will never refer pain patients to DCs because of their inbred chirophobia; also their lack of informed consent to tell patients of the new guidelines is criminal. This embedded bias needs to be address by your news org to expose the remaining problem isn’t research-based guidelines or “best practices,” but the real problem are inept MDs who mislead their patients. There should be an immediate moratorium on fusions to redress this sad situation of medical malpractice. Learn more @ http://chiropractorsforfairjournalism.com/Moratorium_on_Surgery_2.html

    • It’s not just “bigotry”, although I’m sure part of it is something like that. Some chiropractors propagate some really squishy, implausible beliefs that set of many people’s BS meter. I’m not saying that all chiropractors are like this, but some are. I know someone who’s been to chiropractor school and I think even got certified, but she believes 17 impossible things before breakfast. I’ve heard more toned down versions of this in chiropractors’ offices. OTOH, the chiropractor who helped me the most didn’t push any strange theories at all.

    • JC, your core message is an important one, namely that we have better strategies to treat *non-specific LBP* than resorting to interventional procedures. And most radiculopathies can be better treated by reassurance and coaching to remain active, whether in the form of a scientifically sensible PT or DC. One thing we DCs get wrong, however, is that we do not yet have a good explanation for the mechanisms behind spinal manipulation. “Joint dysfunction” in its myriad forms (i.e., “segmental dysfunction,” “somatic dysfunction,” “joint hypomobility,” etc.) is no more specific than the infamous “chiropractic subluxation.” We need to own this and say that we do not have a mature explanation at this time for why SMT works. That’s fine to do.

  • Back pain is not a diagnosis. It is a symptom and more specific management strategies have to be in place to investigate, diagnose and offer a step wise progression in treatment. I think it is inappropriatewhen layman or non surgeons discuss the role of surgery in this light and in this kind of forum. It is extremely misleading and adds to more confusion among patients. It is absolutely criminal and ignorant to be saying stupid blanket statement ‘fusion is not necessary or useless or more crippling for patients’.No body else spends more time understanding and investigating and trialling different therapeutics manoeuvres than us, spinal surgeons. Like anything in medicine, when something is abused or over treated or poorly screened or indications are inappropriate and never forget that patients already undergoing treatment are already injured and or degenerated. Spine as a whole is a 24 moving bones and spine fusion of limited segments is not like treating a whole responsible anatomic organ….like a heart or lungs or kidneys or hip joint. Shameful article with such little insight.

    • Thank you. When people use the the word always or never they usually do not really know the whole truth no matter what the subject is. When a back patient get to the point of seeing a surgeon most people nave taken tons of med, done PT had epidurals (which are not have been FDA approved) annd have had nerves burned and other expensive temp invasive treatment. My fusion failed and now my who spine turned into a massive mess. But when I went into this I knew it may not work. However I do think you have only so many chances to fix a the problem and after so many back surgeries you are wasting your money because they rarely work. I have heard of people having as many as 10 surgeries hoping for relief. Well I have been a pain med for 15 years and on the same dose and my pain is well controlled. I exercise, live on my own and live as full a life as someone can with a back like mine. Without opiate them I cannot even get out of bed. Believe me I have tried. I have also tried other opition like medical marijuana and Kratom with no help. Opiate medications is not the best for every patient. But what medication is? Also opiates are taken as prescribed and not combined with alcohol or other things that depress your brain and breathing tney are fairly safe. We have alway had addicts in the world and now we blame chronic pain patient and are allowing them to suffer. Meanwhile the addicts have move to more deadly drugs and it is are fault that happened. However 85% of those who abuse opiate pain medication do not get them from seeing a doctor but from the street. I also know many chronic pain patients who have done very well on opiates. As far as side effect most go away or can be dealt by changing eating habits ( the constipation everyone talks about) Medical care is suppose to be individualized but instead insurance companies have dictated every part of our care. What doctors we can see, what medication they will pay for, how many pill you can get, whether or not they will approve a test or surgery. In fact our doctors spend more time dealing with trying to get things approved for patients thought their insurance companies instead of examing and talking to them. Insurance has ruined our healthcare system and the USA pays higher cost then any other place in the world because of this horrible profit making system that we have allowed to take over are healthcare.

  • Here are 6 things to know about journalists. #1) their formal education gives them no scientific expertise #2) their preconceived biases cause them to search for information to quote that reinforces their position #3) articles that attempt to intellectually examine a complex issue don’t sell as well as hit jobs #4) the editorial process fails to reject poorly written pieces #5) just like doctors, they get paid to create certain content, so they generate that content #6) they have no accountability for erroneous reporting unlike doctors who are penalized 100,000% of the value of a procedure if there is a problem.

    • Please note any randomized trials that show the benefit of spine fusion. The journalist did note a paper though it was a “historical cohort” . Your comments would have more weight with reference to trial and study data.

    • Agree with Titus. I’d like to see both sides of the issue, but all we have here is a rant against journalists with no supporting data.

    • There isn’t enough room on this platform to list the Cochrane Database of Evidence Based Medicine regarding spinal fusion. According to the Ovid search that I performed for Titus and Nick, there are 761 Randomized Controlled Trials listed to support the value and efficacy of spinal fusion. There are 42 articles in the Cochrane Database of Systematic Reviews, considered the gold standard for the establishment of medical necessity. As has already been established, this platform isn’t suitable to scientific discussion. Instead we get to hear about the ultimate voodoo–spinal manipulation.

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