At its worst, back pain isn’t just a physical condition. It spreads beyond the body, impacting many other aspects of life. Back pain is a top cause of lost days and limitations at work, and adults who report challenges at work because of back pain earn less than their peers without such pain.
Back pain can also compromise emotional and mental health. More adults with back pain report fair to poor mental and physical health than do adults without back pain. Nearly three-quarters of those who experience back pain say they’ve experienced feelings of sadness, worthlessness or hopelessness so intense that these emotions interfere with other parts of their life.
Given these realities, it’s unsurprising that sufferers would leap at anything that promises to heal their pain. And that’s precisely what advocates of ultrasonic spine surgery claim.
WHAT IS ULTRASONIC SPINE SURGERY?
Ultrasonic spine surgery purports to be a cutting edge minimally invasive surgery that incorporates the use of ultrasound waves in order to minimize disruption of normal tissue.
Minimally invasive spine surgery is a catch-all term that encompasses a number of different approaches and different tools. Lasers, ultrasonic scalpels and endoscopes are all tools that can be used in both open and minimally invasive spine surgeries (MIS).
This means that just, because a surgeon is using a laser or ultrasonic scalpel, they may not necessarily be performing a surgery that is truly minimally invasive. The key to any surgery is not just the tool but the approach coupled with experience and the skill of the surgeon who will employ the best tools for that particular patient and situation.
Traditional open spine surgery involves widely exposing the spine through big incisions. In contrast, surgeons use CAT scans, 3D images, robotics and other tools to complete a procedure that exposes much less of it. According to MedStar Georgetown, traditional surgery is the best option for about 20% of the cases its team handles, but MISS techniques are better in the vast majority of cases.
Doctors using ultrasonic devices for the spine claim that this proprietary technology makes surgery safer and better. The ultrasonic tool causes less disruption to bones, joints and tissue, pain alleviation which translates into a faster recovery time than traditional spine surgeries.
All of these are attractive benefits – particularly when you’ve been managing pain for years on end and want to reduce time spent in recovery after surgery. Why wouldn’t patients seek it out?
Just because ultrasonic tools are used in spine surgery doesn't mean that the surgery itself is minimally invasive. The key to any surgery is not just the tool but the approach coupled with experience and the skill of the surgeon who will employ the best tools for that particular patient and situation.
SONIC SUPERPOWERS? STAY SKEPTICAL.
When push comes to shove, patients should be especially skeptical and proceed with caution when products promise extraordinary results.
Ultrasonic tools are widely used in traditional healthcare settings, and not just in spine surgery. Most likely, your local hospital has ultrasonic spine tools in its operating room. But, they’re just tools, not the miraculous, cure-all piece of futuristic equipment that marketers make them out to be. They can be helpful in specific instances, but there are by no means a magic wand that can cure back pain in all its various forms.
You actually live with this healthy skepticism more than you might think.
If a surgeon urges you to go out-of-network and pay cash to receive an ultrasonic spine procedure, think critically about why you’re being asked to do so. Sometimes, you need the specific expertise of a rock-star surgeon and it’s worth going out-of-network to benefit from their specialization, but more often than not, it’s a marketing ploy to get you to pay out of pocket for a procedure you could have received in-network.
This is a ploy that’s been used in healthcare marketing for years. Physicians will claim to have an exclusive, groundbreaking tool that can help treat your specific condition. The only catch is that you’ll have to travel or go out of network in order to get the surgery.
The reality is that the physician is actually performing the same surgery that you could get at a local hospital sometimes not even using the very tool that brought you in the door. The only difference is that they’re able to get cash directly from you as opposed to negotiating rates with an insurance provider.
Be wary when you hear promises of a groundbreaking new technique or tool that only one doctor or practice can provide. Remember: it’s in a manufacturer’s best interest to sell as many units of a medical device as possible. If the tool really was as game-changing as the manufacturer says it is, why isn’t it in use at hospitals across the country? “Exclusivity” might be a worthwhile business value in certain industries – luxury retail or entertainment, perhaps – but it’s not a marketable value in the medical device space.
Many of the surgeons who advertise ultrasonic spine surgery are performing the same standard procedure that other doctors would perform – the only difference is that they sometimes use the ultrasonic device. And if you’re getting the exact same procedure with a device that has yet to achieve widespread usage, it makes little sense to go out-of-network and spend out of pocket when insurance would be willing to cover it in-network.
Patients should be especially skeptical and proceed with caution when products promise extraordinary results. Be wary when you hear promises of a groundbreaking new technique or tool that only one doctor or practice can provide.
Laser-Like Marketing Strategies
You might be wondering why surgeons advertise ultrasonic spine surgery when it’s not standard practice across the country. The answer is a simple one: Marketers know this strategy works.
How do they know? Just look at the success of laser spine surgery. MedStar – the not-for-profit healthcare organization that runs Georgetown University’s hospital – has rightfully pointed out that “No recognized health authority in the United States recommends laser spine surgery.”
Yet that hasn’t stopped doctors from across the country from offering laser spine surgery, touting it as safer option than traditional spine surgery. In 2011, Bloomberg reported that Florida’s Laser Spine Institute LLC boasted higher profits than Google. (The company closed in March of last year, due largely to poor business decisions and internecine lawsuits).
Companies do this because they know consumers find the idea of laser surgery attractive. As Mark R. McLaughlin, neurosurgeon and founder of Princeton Brain, Spine and Sports Medicine, observes: “Lasers have always connotated cutting-edge precision. It is only natural that introducing this into surgery could be considered by the public as something that might benefit and enhance procedures.”
But there is still virtually no evidence that lasers improve outcomes for spine surgeries. Indeed, it makes more sense to use other tools. Lasers are straight, which makes them ineffective for cutting edges and corners. Lasers produce heat, which can be incredibly damaging if used incorrectly. And if held in one place for too long, lasers can do damage to structures beneath the area being treated. Endoscopes, scalpels and electrocauteries might seem less sophisticated than a laser, but they are far more reliable for the delicate work of spine surgery.
What’s more, there’s reason to doubt that patients who undergo laser spine surgery experience all the benefits proponents of the surgery say they will. The Bloomberg reported that serious outpatient complaints were more frequent for laser spine surgeries than for other outpatient procedures.
Similarly, BlueCross BlueShield of Kansas provided an overview of research on the use of lasers in various spinal procedures. According to the National Institute for Health and Care Excellence (NICE), the evidence on laser lumbar discectomy for the treatment of sciatica “is inadequate in quality and quantity.” And according to the American Society of Interventional Pain Physicians, evidence for percutaneous laser disc decompression was limited.
Other BlueCross Blue Shield offices have come to similar conclusions about the use of lasers in the decompression of the intervertebral disc. This alone should be enough to give patients pause. Insurance companies want to minimize costs and maximize outcomes. If laser surgery genuinely reduced costs and led to better long-term results, these companies would actively advocate the procedure to patients struggling with back pain.
But they don’t – and that silence is telling. As Dr. McLaughlin wisely notes: “If one person or group does laser surgery and markets it, it is a gimmick. When a number of surgeons adopt the technique and long-term studies demonstrate safety and significant benefit, then laser spine surgery may be a legitimate option.
Neither of those things has occurred yet. Nevertheless, patients continue to buy into the extravagant claims of marketers and go out of network for laser spine surgery, shelling out thousands of dollars when they could stay in network and have the procedure covered by insurance.
Doctors know that patients like to think the surgery they're getting is "futuristic" and will enhance their procedure, but often these claims aren't backed by science or recommended by recognized health authorities.
Picking A Surgery Facility Wisely
Small wonder, then, that marketers have chosen to build on this success. Ultrasonic spine surgery claims to offer many of the same benefits as laser spine surgery (faster recovery time and less blood loss, for instance), poising patients to make the same mistake that they would with laser spine surgery.
The good news is that there is a simple way to avoid making this kind of mistake: Picking the right facility for your operation. Many of the biggest proponents of seemingly cutting-edge technologies like lasers and ultra-sonic tools are small private, often super specialized facilities. By contrast, you won’t see mainstream, general hospitals advocating the use of these tools.
That’s because big hospitals only use technology that has been rigorously researched and vetted. Given the choice between a private practice hyping futuristic technology and a large institution, choose the latter.
Experimental surgeries certainly have their place in research and the advancement of medical knowledge. But there’s no reason to subject yourself to the use of tools with as-yet unproven benefits.
Successful surgeries without these tools take place each and every day.
Until the evidence in favor of ultra-sonic spine surgeries becomes more compelling, it’s not worth it to add in the risk of these tools.
Many of the biggest proponents of seemingly cutting-edge technologies like lasers and ultra-sonic tools are small private, often super specialized facilities. By contrast, you won’t see mainstream, general hospitals advocating the use of these tools.
Back to Back Basics
There’s a reason doctors spend ten years or more in training before they formally begin to practice medicine. The human body is an incredibly complex and delicate organism – far more sophisticated than even the most advanced technology we have. Doctors need every minute of that education if they want to provide the best care possible to their patients.
The extent of this training, however, means that there’s a massive knowledge gap between doctors and their patients. This isn’t bad in and of itself – but it does create problems for medical advertising. Much of medical marketing is direct-to-consumer, attempting to persuade the patient that a certain pharmaceutical, surgery or tool will help alleviate their pain or manage their condition.
The reality, however, is that the vast majority of patients simply don’t have the expertise to determine whether the product or service being advertised is actually safe or reliable. This lack of expertise isn’t exclusive to medicine; it’s a challenge in the technology, manufacturing and automotive spaces as well. No one can be a specialist in all areas, which is why we rely on experts to cull through the research and come up with the solutions that genuinely work in our best interests.
Medical advertising, however, uses the consumer’s lack of expertise to its advantage, marketing products and services that have yet to be validated by thorough research as a cutting-edge solution.
From a physician’s perspective, this can be incredibly frustrating. Back pain is a difficult condition to manage, with many patients trying all different kinds of solutions before they find the one that works. As physicians, we constantly strive to provide our patients with the strongest possible solution for their unique needs.
To see patients in pain taken in by a slick marketing campaign plugging a questionable surgical procedure is not only frustrating from a professional perspective, but from a curatorial one as well. Keeping abreast of new research and collaborating with patients to create a workable care plan is difficult enough on its own. Fighting misinformation is an added challenge no doctor wants to tackle if he or she can avoid it.
As a patient, the best thing you can do to protect yourself from these outlandish claims is trust your doctor. He or she is your best advocate when it comes to assessing what surgical tools and procedures are best suited to your needs. Together, you can develop an approach that will empower you to live the healthiest, most fulfilled life possible.