If you are suffering with chronic pain syndrome from spine conditions such as spinal stenosis, surgery may be an option that you are considering. With all of the spine clinics popping up, spinal surgery seems to be rapidly gaining popularity as the treatment of choice for conditions like slipped discs, degenerative disc disease and spinal stenosis.
Spinal stenosis is a common cause of chronic back pain, especially in older people. Surgery is often recommended for those who don’t improve with other prescribed treatments.
If you are considering surgery for yourself, you may tend to head straight for the nearest specialty hospital or spine health clinic. And why not? After all, isn’t a hospital clinic that specializes in spine surgery the best place to go? Well, perhaps not, according to a recent study published in the June 2012 issue of Neurosurgery, which is the official journal of the Congress of Neurological Surgeons.
According to this study, it is not the specialty hospital or clinic that may give you the best outcome but rather the experience of the individual surgeon:
For patients undergoing surgery for spinal stenosis, the risk of complications is higher when the surgeon performs very few such procedures—less than four per year… In contrast, the complication rate is not significantly affected by the volume of spinal stenosis surgeries performed at the hospital.
‘Very Low’ Volume Surgeons Have Higher Complication Rates
In this study of approximately 49,000 patients who had surgery for lumbar spinal stenosis, the rates of complications and in-hospital death were analyzed and compared for surgeons and hospitals with varying numbers of this surgery from the years 2005 to 2008.
Categorizing the experience of the individual surgeon, if the number of surgeries done was less than 15 over the four years, the volume was categorized as ‘very low’. If the surgeries numbered 81 or higher, the volume was considered ‘very high’. Analyzing the complication rate of the surgeon, the study found that the:
Complication rate ranged from 11.6 percent for patients operated on by surgeons with a very low volume of spinal stenosis surgeries to 8.6 percent for surgeons who performed a very high volume of procedures.
When the results were adjusted for other factors, the final risk for complications and in-hospital death was 38% higher for those surgeons categorized as ‘low volume’ compared to the very high volume surgeons. Those surgeons categorized in the low, medium or high did not have a significantly increased risk of complications.
Specialty Spine Clinics or Hospitals
After the adjustment was made for the individual surgeon’s volume of surgeries performed, the volume of spinal stenosis surgeries performed at the specialty spine clinic or hospital did not significantly affect the complication rate.
“The finding suggests that for patients undergoing surgery for lumbar spinal stenosis, the individual surgeon’s experience, skill, and clinical knowledge may be key determinants of outcomes, whereas hospital resources may be of secondary importance,” as reported in Neurosurgery.
Reporting on their findings, the researchers warn that centralization of spine surgery into centers of excellence as suggested by prior researchers may not be necessary, and that procedural centralization should be done with caution.
The research revealed that 40% of the higher-volume surgeons did not work at large university hospitals or specialty clinics. Many of them worked at the smaller or rural hospitals.
“Therefore,” the researchers concluded, “the resources of a large academic medical center or a large, urban hospital may not be necessary for a high-volume spine surgeon.”