A new study published in the journal Health Affairs has shown no significant change in the severity of injuries and hospitalizations for patients receiving spinal fusion surgery during a Department of Defense program between 2009 and 2015.
The study, which is authored by several former fellows at the Uniformed Services University of the Health Sciences and the American National Standards Institute, finds there was “no significant reduction in the magnitude of disability and changes in adverse medical events” by comparing patients who underwent spinal fusion surgery at C.D.C. Joint Replacement Center during a 2013-2015 period compared to patients receiving similar surgery in a control group.
“Although some patients who had the initial intervention had a significant reduction in chronic pain and disability, this finding did not translate into a significant lower percentage of individuals suffering from these conditions seven years after surgery,” the study reads.
The study of approximately 5,000 patients comes as the Defense Department faces growing questions about its spending on procedures related to joint replacement surgery.
“Our new estimate that the primary intervention has resulted in no change in the overall incidence of functional disability demonstrates this ongoing and unnecessary financial burden for service members and veterans,” said CUHS medical school professor Michael W. Peters, who led the research.
However, Peters noted that several things can happen between this study and a research that came out in February 2017, and the focus on apparent effects on disability should not be taken as a reason to stop the program altogether.
“The question is whether good science has finally caught up with what physicians have observed with their own eyes,” he said. “And if the answer is yes, I think we should continue to pursue the identified potential good outcomes in this population.”
Furthermore, the study focuses on patients who received the DT1 spine and not the DT2 spine, and typically the subset of patients who receive DT1 surgery are people who have not had herniated spinal discs or lumbar disc prolapse, which could theoretically have been the intended targets of the program to begin with.
Additionally, the study asked patients who underwent the surgery three years after their surgery about their experience, using both household and doctor-administered surveys. Peters noted that a large majority of patients rated their lives as good or excellent and showed a significant reduction in their chronic pain but no significant difference in other factors, such as disability, or their health status.
“Dr. Peters and his colleagues are correct that advances in the science of spinal fusion surgery could help alleviate long-term pain and disability,” said Thomas Buckley, professor and chairman of the Department of Physical Medicine and Rehabilitation at CUHS. “However, the test we use in this study is imperfect because it was designed for a subset of patients who may have had vertebral artery blockage. We need to examine this subset of patients for other reasons, too.”