Written by NASS Executive Committee
The Executive Committee of the North American Spine Society (NASS) read the October 28, 2013 Washington Post story on spinal fusion with great interest and concern.
The issue of unnecessary surgery is of paramount interest to NASS, from many perspectives, including humanitarian, ethical, scientific and economic. Recognizing that the issue of unnecessary or poorly or marginally-indicated surgery is, indeed, a serious issue, it is nonetheless inappropriate to roundly condemn the concept of fusion, per se.
Fusion of the spine is an invaluable tool in the surgeon’s armamentarium to alleviate intractable pain and return patients to healthy, productive lives. As in ALL surgical procedures, the key is the surgical indication for the individual patient. Overuse or underuse are both bad medicine and do the patient a disservice. There is universal support for spinal fusion in cases of instability, fracture, tumor, infection and deformity. Simpler and safer treatments, if available, should always be pursued first. And, before proceeding with surgery, the potential risks and chances of success must be completely understood.
Pain in the lower back is the #1 cause of disability in the United States and worldwide. Neck pain is #4! Together they cause more than 5 million years of disability in the US alone—enough for every person to be disabled by a spine condition for more than six days each year. Patients are demanding access to effective, thoughtful therapies that allow them to remain active and maintain their quality of life.
NASS is collaborating with Medicare and private insurance carriers to develop evidence-based guidelines for surgical intervention and to define conditions that are best treated without surgery. Spinal fusion is currently undergoing rigorous scrutiny; the indications for spinal fusion are being evaluated and re-evaluated constantly in an effort to develop the optimal indications to serve the best interests of the patient.
NASS is a multidisciplinary medical organization dedicated to fostering the highest quality, evidenced-based and ethical spine care by promoting education, research and advocacy. NASS is comprised of more than 8,000 members from several disciplines, including orthopedic surgery, neurosurgery, physiatry, neurology, radiology, anesthesiology, research and physical therapy.