Too often, back surgery is touted as a miracle cure with amazing results. Little attention is given to the fact that few people with back pain are actually candidates for surgery and that it is still unclear whether people end up better off than if they had chosen a non-surgical route. This ABC news story does a decent job of describing these controversies, although the story is flawed in several ways.
The story provides good information on how the likelihood of having the surgery in the U.S. is so much higher than in other countries.
Although the story mentions spinal fusion and physical therapy as alternatives to discectomy, the story should have discussed other options and the pros and cons of each option. The story explains that there is not good evidence that surgery is better than non-surgical therapy. However, the story should have further described the strength of the available evidence.
The story does not quantify the benefit of treatment, does not explain if laparoscopic surgery is novel or not, does not mention costs, and other than to say that sugery is often unnecessary, the story does not discuss harms of treatment, which can be substantial.
Publisher’s note: this story was part of a series on back pain airing that week on ABC World News Tonight. The network should be applauded for dedicating extra time to this important consumer health issue.
The story does not mention costs of discectomy or fusion.
The story does not quantify the benefit of treatment.
Other than to say that sugery is often unnecessary, the story does not discuss harms of treatment, which can be substantial. Though discectomy in general involves a low risk of complications, they occur. In addition, the use of laparascopic discectomy as opposed to microdiscectomy (small surgical incision) hasn’t clearly been shown to be safer or more effective. Rates of complications for spinal fusion are more common than for discectomy.
The story explains that there is not good evidence that surgery is better than non-surgical therapy. However, the story should have further described the strength of the available evidence. The story provides reasonable information about the evidence for spinal stenosis. However, there is no evidence presented for discectomy. The viewer may be left thinking that disc herniations always need surgery. The answer is usually no. Many patients with a disc herniation can be managed without surgery. The body has the ability to fix the disc herniation on its own. It just takes more time.
By accurately describing how often back surgeries are performed, the story avoids disease mongering. The story also provides good information on how the likelihood of having the surgery in the U.S. is so much higher than in other countries. It would have made the point even stronger to state that rates within regions of the U.S. can vary up to 15 fold. What is true is that the differences are even greater among U.S. and European countries.
The story quotes three independent sources.
Although the story mentions spinal fusion and physical therapy as alternatives to discectomy, the story should have discussed other options and the pros and cons of each option. The story does not mention treatment options for a herniated disc. Spinal fusion is not considered an alternative to discectomy for an acute disc herniation. The story also does not mention the option of standard microdiscectomy versus the newer laparascopic discectomy. The option of steroid injections and other non-surgical treatment are not mentioned as well. Spinal fusion is most commonly performed for chronic low back pain thought to be due to a disc problem. There are other indications for spinal stenosis as well. For each of these indications, the treatment options are somewhat different.
The story states that surgery is available. However, though not stated, the laparascopic discectomy presented is not as widely available as the standard microdiscectomy.
The story says that discectomy is a common procedure performed in over 300,000 Americans a year, so it’s clear that it is not a new procedure. What is less clear is how the story implies that the laparascopic discectomy is a new standard, trumping the standard surgical procedure called microscopic discectomy. The jury is still out on whether laparoscopic procedures are safer or equally effective. Nonethless, we give the story the benefit of the doubt with a satisfactory score here.
Because the story quotes three sources, the viewer can assume that the story did not rely on a press release as the sole source of information.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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