Back surgeries are some of the most common operations in Florida, but also the most risky and often unnecessary.
New research proves why anyone suffering from back pain should approach surgery cautiously and choose a surgeon selectively.
Classic back surgery has one of the highest failure rates of any operation (36%), and in a newly released analysis of Medicare data, Florida ranks the highest in the country for the number of low-value and unnecessary back and spine surgeries performed on seniors.
Spine surgeons say too many Florida doctors are operating without expertise and outcomes are predictably poor, leaving patients in as much pain or more. Seniors appear to be particularly vulnerable for failed procedures.
"I have seen patients driven to insanity after failed spine surgery," said Miami orthopedic spine surgeon Georgiy Brusovanik. "The pain is constant and unbearable."
New research shows that U.S. hospitals have performed over 200,000 unnecessary back surgeries on Medicare beneficiaries over the last three years, according to Medicare claims data analyzed by the Lown Institute, an independent think tank dedicated to effective medical care. That's one low-value back procedure every eight minutes.
"We trust that our doctors make decisions based on the best available evidence, but that's not always the case," said Dr. Vikas Saini, president of the Lown Institute. "In spinal surgery, as with other fields of medicine, physicians routinely overlook evidence to make exceptions, sometimes at shockingly high rates."
Lown's research found people with low-back pain caused by aging receive little to no benefit from a spinal fusion to relieve pressure on the spinal cord or nerve roots. In addition, patients with spinal fractures caused by osteoporosis receive little to no benefit from vertebroplasty, a procedure to treat compression fractures in the spine. Yet those surgeries are regularly performed.
"When we are defining low value, the benefits of getting this surgery don't have a substantial impact on the quality of life for the patient," Saini said. "The risks outweigh the potential benefits.
Florida leads the nation in back surgery overuse with more than 14,300 procedures, according to Lown Institute's research. The state ranked highest in the country for the number of spinal fusions and second highest for the number of vertebroplasty operations considered unnecessary or likely to result in poor outcomes.
The horrific suffering from back pain has drawn attention in recent weeks. The social media posts of Luigi Mangione, the accused shooter of the UnitedHealthcare CEO, revealed that he had been suffering from spondylolisthesis, a condition in which a bone in the spine slips out of alignment and puts pressure on the lower vertebrae and the nerves around the spine. His posts indicate he had spinal fusion surgery in 2023. It is unclear whether it was successful.
"There are lots of doctors who perform bad surgery and then abandon patients or blame them for their bad outcomes," said Miami orthopedic spine surgeon Georgiy Brusovanik. "They fail to acknowledge the operation didn't work."
Brusovanik specializes in revision back surgery to correct failed operations. He uses robotics and minimally invasive techniques. "Not every doctor does that," he said. "It's up to the patient to ask the right questions."
Asking the right questions could mean the difference between expensive and invasive surgery and more low-touch procedures with better outcomes.
Patients suffering from back pain should ask a doctor why they have pain, whether the doctor has experience in surgery for their specific problem, and if they can talk to another patient whose surgery was successful, says Dr. Aaron Brooking, a spine and neurosurgeon at Holy Cross Health in Fort Lauderdale.
Brooking said half the surgeries he performs are to correct previous operations. He recommends doing homework to ensure a back or spinal surgery surgeon has experience in the most current techniques.
"Some surgeons don't have the training for complex cases to do what they are doing," Brooking said. "They are too aggressive, don't set realistic expectations, or bite off more than they can chew."
Brooking said before rushing to operate, a surgeon should explain the risks and what to expect after surgery. Often, different approaches and techniques can be used.
"I would never, ever recommend having surgery with someone who is against getting a second opinion," Brooking said. "This is carpentry and electrical work with high stakes."
Saini of the Lown Institute said the promise of relief is powerful when someone suffers back pain. Yet, he said it's concerning that about two-thirds of back and spinal procedures are revision surgeries.
"Quite often, there are alternatives to surgery," he said. "They are not as quick a fix but less risky -- like physical therapy, acupuncture, or pain medication. The starting point should be the frame of mind -- 'Can we avoid surgery?' -- because, for some people, surgery will not get the result they expect."