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Research, Common Sense Say Conservative Treatments before Spinal Fusion Surgery for Back Pain

Arlington, Va.—The American Chiropractic Association (ACA), in response to a recent government report and articles calling into question the rise in spinal fusion surgeries in the United States, strongly encourages patients and health care providers to consider the benefits of a conservative approach to back pain.

“Research supports the use of more conservative treatments as a first-line defense against pain. This sensible approach not only reduces health care costs but also may help some patients avoid riskier treatments altogether,” said ACA President Keith Overland, DC.

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Dr. Overland’s comments follow the release in October of a report from the HHS Office of the Inspector General showing that hospitals that purchased spinal devices from physician-owned distributors (PODs) had higher rates of spinal surgeries than the rate of hospitals overall. The report noted that many hospitals rely on the surgeon’s preference when making purchasing decisions, and in some cases those surgeons have a financial stake in the companies selected. OIG findings show that using a POD did not reduce costs and those hospitals that did generally saw an increase in the number of surgeries performed—indicating clinical decision may have been affected by the business relationship.

A related article published on Oct. 27 in the Washington Post reports that spinal fusion surgery in the United States has risen six-fold in the past 20 years, from 56,000 in 1994 to 465,000 in 2011. The Post analyzed 125,000 patient records in Florida and found that half the rise in spinal surgery cases in that state involved patients whose diagnoses would not normally make them candidates for the procedure. The article added that Medicare estimates more than $200 million was spent improperly on spinal fusions in 2011 because a conservative course of treatment had not been tried first.

Medical guidelines for back pain recommend the use of conservative treatments. Likewise, a JAMA article published in April 2013 encourages patients with back pain to first try conservative treatments--exercises, physical therapy, chiropractic or acupuncture—and resort to surgery only when less invasive options fail.

However, a study published earlier this year in JAMA Internal Medicine confirms that many physicians don’t follow guidelines and instead refer back pain patients to surgery or write prescriptions for powerful pain killers. The latter is part of an epidemic problem of prescription drug abuse in the United States; the number of prescriptions filled for opioid pain killers--some of the most powerful medications available--has increased by nearly 50 percent in the past 10 years to 257 million. Unintentional overdose deaths involving opioids now outnumber cocaine and heroin deaths combined.

“It’s important today for patients facing spine surgery to do their due diligence and ensure no stone is left unturned. There are effective, more conservative treatments that help many patients each year avoid surgery, lessen reliance on addictive pain killers, and get back to their normal lives and activities,” said Dr. Overland.

The American Chiropractic Association (ACA), celebrating its 50th anniversary in 2013, is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and professional ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit:

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