New Spine Study Works to Empower Patients

BURLINGTON, MA (April 13, 2016) – It started with regular back pain, but once he started losing feeling in his feet, Joel Blumberg, a cardiologist, decided it was time to see a spine doctor.

It was at Lahey Hospital & Medical Center where Blumberg met Zoher Ghogawala, MD, chair of the Department of Neurosurgery. Dr. Ghogawala explained to him a new study that he was working on about back surgery. The study, where Dr. Ghogawala is the lead author, has since been published in the New England Journal of Medicine. The study focuses on empowering patients and their doctors to make a joint decision when it comes to back surgery.

“The goal of the study is to provide valuable information to allow the patient and the doctor to make the right decision for an individual patient situation,” said Dr. Ghogawala. In addition, all patients in the study had their films reviewed by an expert panel of spinal surgeons from across the country.

Nearly 500,000 spinal fusions are performed in the U.S. every year. Spinal fusion accounts for the highest aggregate hospital cost ($12.8 billion/ year in 2011) of any surgical procedure performed in U.S. hospitals. Dr. Ghogawala said that the increased utilization of spinal fusion in the U.S. has come under great scrutiny because of the high costs involved, the complication rate and the perception that many spinal fusions fail to relieve back pain. This study compared a simple spinal operation (decompression of nerves in the lower back) directly with spinal fusion. According to Dr. Ghogawala, the results will likely improve the ability for doctors and patients to know whether a spinal fusion is right for individual patients.

So, Dr. Ghogawala gave Blumberg a choice – a decompression procedure or decompression and spinal fusion surgery.

“Through this study we learned that 70 percent of patients do very well with a simple decompression but that a third of patients treated with simple decompression develop instability and benefit from spinal fusion (a second operation) within four years,” Dr. Ghogawala said. “On the other hand, the study demonstrated that 90 percent of patients who undergo spinal fusion surgery do well and that they overall have superior outcomes, but that doesn’t mean fusion is better for everyone.”

According to Dr. Ghogawala, decompression is a simpler procedure, costs less money and has fewer complications than fusion surgery. Additionally, patients can return to work within a few weeks after decompression, while patients who have fusion surgery might be out of work for about three months.

“I just started my own practice,” Blumberg said. “I couldn’t take three months off; it would have destroyed my business.”

So Blumberg and Dr. Ghogawala decided on decompression surgery.

“I knew there was a chance that five/six years down the road I might need a spinal fusion surgery and that up front fusion had a higher success rate,” Blumberg said. “But that wasn’t a viable option in my situation. I was thrilled that someone was letting me participate in the decision-making of my health.”

“There’s no wrong procedure,” Dr. Ghogawala said. “We’re trying to empower patients and doctors to make the right decision for an individual case.”

It’s been five years since his surgery and Blumberg has started developing some back pain again, but he doesn’t regret his decision.

“This was my choice,” Blumberg said. “At that time, five years ago, I couldn’t lose three months recovering from surgery. It made more sense to go with the simple procedure.”

About Lahey Health

Lahey Health is what's next in healthcare, providing a full continuum of integrated health services close to where you live or work. It is comprised of nationally recognized, award-winning hospitals—including an academic hospital and medical center, and community hospitals—primary care providers, specialist physicians, behavioral health services, post-acute programs such as home health services, skilled nursing and rehabilitation facilities, and senior care resources located throughout northeastern Massachusetts and southern New Hampshire.

Lahey Health offers nearly 1,000 locally based physicians providing clinical excellence and an exceptional patient experience in adult and pediatric primary care and every medical specialty, including kidney and liver transplantation; cancer, cardiovascular and orthopedic medical and surgical care; local emergency and trauma care; urological surgery; chronic disease prevention and health management; and pediatric emergency, newborn and inpatient care provided in collaboration with Boston Children's Hospital physicians.

Lahey Health includes Lahey Hospital & Medical Center—a teaching hospital of Tufts University School of Medicine—and Lahey Clinic physician group with practices in Burlington, Peabody and other locations throughout northeastern Massachusetts and southern New Hampshire; Beverly Hospital; Addison Gilbert Hospital in Gloucester, Mass.; Lahey Health Senior Care and Lahey Health Behavioral Services as well as more than 30 primary care physician practices and multiple outpatient and satellite specialty care facilities.

Together, we are making innovative, integrated healthcare more personal and more accessible. For more information, visit LaheyHealth.org and its member websites Lahey Hospital & Medical Center, Beverly Hospital, and Lahey Health Behavioral Services.