Advances in Spine Care Could Save Healthcare System Billions
Posted on: 09/08/2005
Minimally invasive spine surgery could save time and money
David P. Rouben M.D.
River City Orthopaedic Surgeons
Louisville, KY
9/8/05
According to many studies, the second leading medical problem treated by physicians in the U.S. is low back pain. The only medical problem treated more frequently is the “common cold”. It is estimated that 80% of the population will experience low back pain at some point in their life.
Low back pain can cause excruciating discomfort and personal incapacitating loss of daily functional activities. Unfortunately, not only does the patient suffer, but employers know too well the negative, catastrophic, financial ramifications of low back pain to their bottom line. When an employer has to absorb the cost of medical care for a disabled employee, forced to accept the lost productivity due to the lowered output of that unfilled position, and finally, tolerate the financial strain necessary to recruit, retrain and offer benefits to fill the vacated position, the costs to the employer become exponentially high.
Work related injuries will cost the U.S. economy over $160 billion in 2005. Of this cost, 41% is directly attributed to injured workers with low back pain. Of the 126 million workers in the U.S., low back pain will force approximately 25 million or 20% of these workers out of their jobs for up to 6 months. Unfortunately, 70-80% of the incurred workers compensation insurance cost is generated by the 4-5% of workers who are disabled in excess of 3 months. This group, of approximately 630,000 workers each year, will not respond to non- surgical, conservative means of treatment. Unfortunately, their treatment is relegated to an inconsistent spectrum of therapeutic regimens based on their geographic location and localized, mandated, governmental statute.
The incidence of disability from low back pain has grown four times faster (4x) than the growth of the U.S. population. This trend will only continue to grow as the age of the U.S. work force continues to increase. As the size of the U.S. workforce declines, due to the loss of the so called “baby boomers” work force, the remaining employees become more critically important to the maintenance and stability of consistent economic growth and output. Maintaining the health of this work force becomes ever more paramount. The necessity to identify the most consistent and effective means of treating low back pain then becomes the difference between the financial success and demise for both the employee and the employer.
Historically, there have been numerous ways to treat low back pain. Treatment consists of conservative (non-operative) therapy such as rest, restricted activities, oral medications, steroid injections, exercise, and supervised physical therapy. Conservative, non-surgical therapy over the last 20 years has changed very little. Conversely, there have been great strides in the surgical treatment of low back pain of which the most common is a lumbar spinal fusion.
Approximately 213,000 lumbar fusions will be performed in the U.S. in 2005. While the number of minimally invasive lumbar fusion procedures (MAST TLIF) has grown 80% over the past 12 months, it still only accounts for a small percentage of the total lumbar fusion procedures performed. Traditional, open, lumbar fusions, where the spinal muscles are cut, split, and permanently damaged beyond repair, is associated with enhanced post-operative pain, blood loss, significant scar formation, protracted hospitalization and functional and work disability. Due in large part to the non-boney tissue and muscle injury that occurs during routine, traditional surgical exposure, the permanent debilitating effects of extensive muscle stripping and retraction is well documented in medical literature.
Studies suggest, that workers disabled with low back pain for longer than 6 months, will not likely return to work. This demonstrates the importance of offering effective care, with reproducible results, as early as possible. Workers compensation and other healthcare insurers are hesitant and reluctant to approve surgical care for the low back pain patients when the results offer such a poor return for the dollar spent.
In the latter part of 2000, the first minimally invasive lumbar spinal fusion (MAST TLIF) was performed by Dr. James Schwender in Minneapolis. Developed with both, Dr. Kevin Foley of Memphis and Dr. David Rouben of Louisville, these three spinal surgeons began a process that has consistently proven the beneficial effects of using a minimally invasive, muscle-sparing approach to lumbar spinal surgery. This approach has led to major improvements in patient outcomes and the time it takes a patient to return to his usual work.
Traditional studies document that only 50% of those patients who undergo the more traditional, open, muscle-splitting, lumbar fusion approaches ever return to work. There is also a 50-60% recurrence rate of disabling back pain in patients that were thought to have previously recovered when treated in this older, more traditional manner. One study asserts that only 27% of patients who underwent more than one traditional back operation ever returned to work.
By comparison, the minimally invasive lumbar fusion (MAST TLIF) patients spend 88% less time in the hospital, 50% less time in recovery, take 50% less narcotics, lose 33% less blood (eliminating the need for intra-operative blood collection or post-operative transfusion), and have 70% less pain than before surgery. Although the equipment cost is slightly higher, the minimally invasive lumbar fusion procedure (MAST TLIF) total cost of care is approximately $24,300 less than the more traditional open lumbar fusion technique (Open TLIF).
If the projected 31,000 traditionally approached open lumbar fusion (Open TLIF) procedures to be performed this year in the U.S. were performed as minimally invasive lumbar fusions (MAST TLIF), the savings to the insurance industry would total approximately $753 million dollars. If all lumbar fusion procedures were performed with the minimally invasive approach (MAST TLIF), then savings to the healthcare system would be over $5.2 billion dollars.
This does not even take into consideration the savings to employers by returning an employee back to work to his or her previous job, or the economic value of the employee working and earning his or her normal wages, instead of drawing a disability payment. Almost 90% of those patients who have undergone the minimally invasive spine fusion technique (MAST TLIF) have returned to work within 10 weeks of their surgery.
Patients who have undergone a minimally invasive lumbar fusion (MAST TLIF), recover quicker, go back to their own work faster, experience less post operative pain, incur less blood loss, enjoy a much shorter hospital stay, and take fewer narcotics. This procedure can play a major role in reducing the high cost of medical healthcare for both workers’ compensation and third party insurance carriers.
Although the minimally invasive lumbar fusion procedure (MAST TLIF) offers great advantages, to low back pain patients undergoing spinal fusion, over and above the more traditional technique, it is still not readily available to patients in many communities. Many spine surgeons have not felt it cost effective to spend time learning a new technical approach to performing a spinal fusion. The rule of supply and demand, which continues to direct healthcare advances, penalizes a physician’s motivation to learn something new that offers such a profound and enhanced patient benefit.
But times are changing. The U. S. healthcare industry is rapidly transitioning to a system that rewards both beneficial treatment outcomes and patient satisfaction data as the determining factors for patient access and reimbursement. The option of a minimally invasive spine fusion (MAST TLIF) fits quite nicely into this new and fiscally efficient approach in a healthcare provider’s commitment to offer a proven and beneficial product for less.
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