Anyone want to hear my unsolicited, cynical, self-aggrandizing and over-simplified yet amusing opinion?
I think they just found a way to save $400 mil from their budget, (See art. ref. above in Harrison’s comment). No wait a mintue …now I’m being just plain silly…..what government agency anywhere in the world would do a suicidal thing like that?
There are three major treatments for severe and prolonged lumbar back pain:
1. Fusion
2. Physical Therapy*
3. Lumbar Artificial Disc Replacement(LADR)
*(a/k/a special cross-discipline PT) They claim it’s not just PT, but a cross-disipline, multi-specialty whole-patient approach where your entire health care team actively communicates through follow-ups and conference with the patient and the whole team, if poss. (Whew. Sounds impressive doesn’t it?).
Putting it very simply recent studies have shown:
ADR vs. Fusion = ADR wins
PT vs. Fusion = PT wins
Doing nothing vs. Fusion = Doing nothing wins, ref.the
Spine Patient Outcomes Research Trial (SPORT). (not sure about this one I read the study results and it is not easy to say
Having experienced this 3-week treatment for a multicenter study in Bergen, Norway. In my humble opinion, it was just PT with good follow-up. Please pardon my sarcacism but, I thought that used to be called simply called doing one’s job well.
In Mirza’s presentation below you will see reference to a small study in Norway. Well the subsequent study I was involved in had 300 patients (50%/50% PT vs. ADR) with a 2 yr follow-up prior to publication. They are expected to publish in the summer of next year, 2007
“What the heck is she talking about?!!” ……………….you quietly ask yourself?
I think they are hearing about the studies in UK, Norway and Sweden where the ADRs are being compared to this special type of PT, ref. the reference Mirza presentation. If you can stay awake in the middle where Mirza wanders off into the quasi-science of statistics, tests and studies, the beginning and end of this presentation have some very interesting info on ADR and comparing them to PT instead of fusion, like they are doing in the US studies. and PT (I link the
NASS Spring Break Itinerary because it has oodles of informaiton. You’ll find the link to the referenced presentation at the very bottom of the page.)This was the 3rd presentation given by Mirza during NASS’s 2006 Spring Break meeting, ref.
Quote:
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Surgery for Chronic Back Pain: Artificial Disc Replacement - Methodological Concerns
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,
Sohail K. Mirza, MD MPH
I especially like his simple and direct conclusion: "Lumbar fusion for chronic low back pain offers little or no benefit compared to
non-operative treatment. Artificial disc replacement is not inferior to lumbar fusion."
If you live life by the premise that money is everything and you would do anything for everything, or something like that. I don’t (allegedly) but it’s a pretty good predictor of human behavoir, don’t ya think?
If fusion is a defunct surgery, as the ADR studies are showing, then (CMMS) is probably wondering “Why are we covering for 2 types of expensive surgeries when one of them isn’t even as good as doing nothing….(or is that “as good as PT”, I get confused)??!!
They might not be able to get rid of fusion altogether, but decreasing it to an earlier level…say the $80 million of 1993 …..and presto……CMMS has $400 million.
Happy reading.
Trish
P.S. Harrison, you might want to delete this from the string before you forward it to CMMS....lol