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MRIs plus low-back pain equals more dubious surgeries

October 14, 2009 | 12:01 pm

Areas of the country with the highest number of MRIs have the highest incidence of surgery for lower-back pain, despite the lack of evidence showing that the surgeries are beneficial, Stanford researchers reported today in the journal Health Affairs. Previous studies have shown that increased surgery rates for back pain don't improve patient outcomes, "so heading in this direction is concerning," said senior author Laurence C. Baker, a professor of health research and policy at the Stanford University School of Medicine.

Between 2000 and 2005, the availability of MRI scanners in the United States more than tripled, from 7.6 machines per 1 million persons to 26.6 per million. State-of-the-art scanners cost more than $2 million apiece, so scans are expensive--about $1,500 for one low-back scan. The increased use of the scanners and the growing number of surgeries that result from such scans are one component in the increase in healthcare costs, Baker said.MRI

Baker and Jacqueline D. Baras, a medical student, obtained Medicare claim data from 1998 to 2005 for about 20% of patients with non-specific low-back pain and compared it with data on the availability of MRI scanners, as determined by IMV Ltd., a healthcare consulting firm that provides such data to the medical industry. They found that the number of scans for low-back pain and the number of resulting surgeries in each of the 318 Metropolitan Statistical Areas were directly proportional to the availability of scanners. About two-thirds of the scans, moreover, occurred in the first month after the onset of pain, despite clinical guidelines that recommend at least a one-month delay because of the large number of patients who spontaneously recover.

"The net result is increased risks of unnecessary surgery for patients and increased costs for everybody else," said Dr. John Birkmeyer, a professor of surgery at the University of Michigan who was not involved in the study.

-- Thomas H. Maugh II

A state-of-the-art MRI can cost $2 million.

Credit: Jim Cole / AP

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Comments (5)

This is what Orthopaedic Surgeons have been saying for years but guess what? PATIENTS demand MRI scans because they feel like they 'deserve' it otherwise they don't feel like they are getting good care. Don't lay all this unnecessary testing on physicians. With all this patient 'enlightenment' here is the price. A little information is a dangerous thing.

And we blame the insurance industry for this?!?! And we think that a "public option" to insurance makes stuff like this go away?!? Give me a break. Read carefully: 1) Dr's order the equipment. 2) Dr's order the scans on the patients. 3) Dr's recommend and perform the surgery. They get a free pass from insurance plans. Without question, our medical problems need changed but laying the blame on the insurance co's doesn't necessarily fix the problem. Dr's are also saddled with high rates of malpractice insuracnce because moron's take them to court at the drop of a hat. I agree there's a serious problem but the current plans for overhauling healthcare are window dressing that won't fix a thing. And this clearly illustrates the problem

This is no surprise - the lack of ionising radiation in MRI scanners encourages people to see them as having no downside, so they can be recommended almost on a whim. Given the difficulty of interpreting MRI scans (and the lack of any consensus about what the causes of back pain are, never mind what they look like on a scan) then it's likely that something will be seen that can be interpreted as requiring surgery.

The US operates on a much higher percentage of back pain cases than any other country. In Europe, many more people receive rehabilitative therapies than surgery. Whether that corresponds to better outcomes isn't clear - a study published 2 weeks ago suggested 100m Europeans are suffering chronic back pain and other musculoskeletal disorders, and prevalence rates seem pretty comparable to the US.

It's amazing that such a common condition as back pain is still so poorly understood

A) I guess that's how Canada can afford national healthcare.
No access, no test, no cost. Alas, many Canadians go south of the border for their MRIs, CTs and other advanced tests.
B) Why is it so hard for doctors and patients to discriminate between making an accurate diagnosis (that is what the doctor is supposed to do) and prescribing a treatment? Patients must be educated to ask three key questions: 1) How will the results of the test change my treatment? 2)What are the alternative treatments? Proper informed consent requires discussion of treatment options and telling a patient you have two alternatives. surgery or no surgery, is unacceptable. Physicians should be required to empathetically share outcomes data with patients. 3) What if I don't have or if I delay surgery?
C) Why don't hospitals do active and earnest peer review? The Joint Commission requires "ONGOING PROFESSIONAL PRACTICE EVALUATION." Reason is that often the outliers who do the "unnecessary surgeries" are a profit center for the hospital. It is imperative for Medical staffs to maintain their independence from the hospitals' administration much as the judiciary must maintain theirs. Of course, if physicians are employed by a hospital system, they might be under a little pressure to fill the ORs and the beds. Maybe if doctors were actually compensated fairly for their time devoted to counseling and actually talking with patients, they would hopefully do so with the net result being fewer tests and unnecessary proceedures (arthroscopic knee surgery for osteoarthritis). CPT codes 00401 through 99409 "Counseling Risk Factor Reduction and Behavior Change Intervention" are rarely if ever paid by insurance companies.

i am having a lower back pain in right side since a week time ....wanted to know why is happen and no medicine can sure this



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