There was another tragic mass shooting this week in Oklahoma. As mass casualty events go, however, this one was different than many. Most of the mass shootings that have occurred in recent months have been essentially random attacks with little intent other than the illogical desire for great destruction. This one in Tulsa, on the other hand, was a distinctly targeted event. A patient suffering increased pain from a failed back surgery targeted his surgeon, as well as “anyone who got in his way” when trying to kill him. He was unfortunately successful in his efforts, killing his surgeon and 3 others before shooting himself in a Tulsa medical office.

Failed Back Surgery Syndrome is not an unfamiliar phenomenon to many in the workers' compensation industry. Stories abound regarding injured workers who receive fusions or other back procedures that ultimately fail, leaving them in more pain and with greater disability than they had prior to the surgery. Yet these procedures seem to continue unabated, with no clear instructions being provided to the patient of the significant risks involved.

Spine-health.com says Failed Back Surgery Syndrome isn't really a medical condition but rather a “very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery.” I am sure the clarification is of little comfort to the many people who are suffering with increased pain from procedures that never should have been performed. In fact, the peer reviewed spine-health.com article goes on to explain that “By far the number one reason back surgeries are not effective and some patients experience continued pain after surgery is because the lesion that was operated on is not in fact the cause of the patient's pain.” It also says that “a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful,” and “a fusion surgery for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient's pain after surgery.”

According to a paper published in the National Institute of Health's National Library of Medicine:

Between 1998 and 2008, the yearly number of lumbar fusion surgeries performed in the United States increased from 77,682 to 210,407, with the total number of spinal operations exceeding one million in 2002 [7,8]. The direct yearly cost of spinal fusion surgery in the United States was over US$ 16 billion in 2004 [9], whereas the overall failure rate of lumbar spine surgery was estimated to be 10%–46% [10]. Given that these rates have not changed substantially over the years despite advances in technology and surgical technique, the number of patients developing FBSS can be expected to continually increase [11]. […] Repeat spinal surgery is a treatment option with diminishing returns. Although more than 50% of primary spinal surgeries are successful, no more than 30%, 15%, and 5% of the patients experience a successful outcome after the second, third, and fourth surgeries, respectively [12].

The question here is why these procedures are being performed with such little acknowledgment of the risks involved being shared with the patients. This is a bit personal for me, as my wife has been suffering from a serious back problem for the last few years. She has visited several surgeons in search of an effective treatment. Each one ultimately told her that a fusion is the only solution available to her. None of them mentioned the potential for failure or increased pain and disability. All were quite confident in their abilities and the potential for a positive outcome. One was extremely cavalier in his attitude; when questioned about the potential for failure told us “If there is any problem we can always operate again.”

No thanks. That's a hard pass for us.

We would never condone the type of violence that occurred in Tulsa and certainly can grieve for the loss of innocent people in another senseless act of violence. But having met several people over the years who have suffered failed back procedures at the hands of surgeons who never discussed the possibility of the same, I understand the frustrations that situation can produce. This should be a wake-up call for workers' compensation professionals, as well as the doctors and attorneys who ultimately profit off these procedures, to understand the risks involved and to ensure that patients are well advised in the process.

As evidenced this week in Tulsa, failure to do so may have tragic consequences beyond the patient themselves.

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All posts From Bob's Cluttered Desk are now also available on www.bobscluttereddesk.com

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