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Read Original Story

Back Surgery Not Always the Cure for Pain

Rating

3 Star

Back Surgery Not Always the Cure for Pain

Our Review Summary

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.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention costs of discectomy or fusion.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story does not quantify the benefit of treatment.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

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.

Does the story seem to grasp the quality of the evidence?

Satisfactory

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.

Does the story commit disease-mongering?

Satisfactory

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.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes three independent sources.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

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.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story states that surgery is available. However, though not stated, the laparascopic discectomy presented is not as widely available as the standard microdiscectomy.

Does the story establish the true novelty of the approach?

Satisfactory

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.

Does the story appear to rely solely or largely on a news release?

Satisfactory

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.

Total Score: 6 of 10 Satisfactory

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