More Spent for Worse Outcomes

Spine problems and their treatment account for a very large part of health care expenses. We need to evaluate the effectiveness of some of the newer treatments. Spinal instruments implanted into the back to fuse vertebrae, stabilize the spine, and even replace discs have proliferated greatly in the past 10 years. Between 1997 and 2006 expenditures per patient to treat spine problems increased by 65%, yet measures of outcome such as physical functioning, social limitations and ability to work actually got worse. Most of the cost increase was due to increased hospitalization, increased use and cost of drugs, and increased use of emergency rooms.

For a full discussion and a study of this phenomenon, see:
www.medscape.com/viewarticle/710366?sssdmh=dm1.555267&src=journalnl&uac=140674AR

Personally, I think a big reason is the increased use of implanted hardware for questionable indications. The only proven value of spine fusion is a condition called spondylolisthesis with instability and unstable fractures. Fusions done for back pain only often make patients worse. The most useful and reliable treatment in spine surgery is surgery for a herniated disc when it is causing incurable pain and/or nerve or spinal cord damage. Most of those procedures can be done as day surgery or with only an overnight stay.

Acupuncture for Tension Headache

A new study has found that acupuncture is a useful treatment for tension-type headaches. See:
http://www.medscape.com/medline/abstract/19160338?cid=med&src=nlbest