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
Puleeeeease... this 'game changer' weight loss drug causes more nausea and vomiting than a placebo. Some game, some change. My friend Gary would spank you for using the eighth word medical reporters should never, ever use. @garyschwitzer @thackerpd
https://www.healthnewsreview.org/toolkit/just-journalists-writing-tips-case-studies/7-words-and-more-you-shouldnt-use-in-medical-news/ https://twitter.com/OttawaCitizen/status/1361426796126830597
A scary @statnews Op-Ed warns that govt attempts to rein in Pharma may cut off access to "life-changing" drugs.
It takes @garyschwitzer to let us know: the author spent 10 years as Pfizer's public-policy chief. https://twitter.com/garyschwitzer/status/1360325022578053123
.@TranspariMED criticizes STAT op-ed for not disclosing pharma funding of author’s institute - similar to criticism we’ve made of STAT op-eds in the past. @transparify @ThinkTankWatch @icer_review https://www.healthnewsreview.org/2021/02/transparency-watchdog-criticizes-stats-non-disclosure-on-pro-pharma-op-ed/
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like