In an accompanying editorial, Stanford University orthopedic surgeon Eugene Carragee, MD, said Deyo's findings "do not provide explanations for the increase in complex surgery," which might be explained if patients had more extensive deformities.
"The diagnoses reported, however, do not support this 'ideal' explanation; 50% of these new complex fusion operations were performed in patients with spinal stenosis alone and no deformity."
Such "proliferation of risky and expensive practice beyond reasonable supporting evidence is commonly mentioned as a fundamental failing of medical practice in the United States."
More complex technologies for spine surgery are being used for patients "with little specific indication for the approaches and for whom there is good evidence that simpler methods are highly effective." Additionally, he noted, surgeon compensation for a simple decompression spinal stenosis is approximately $600 to $800, compared with complex fusion, which pays "10-fold greater."
The study by Deyo "demonstrates a definite human cost to this practice in terms of a clear increased risk of surgical mortality, major complications and prolonged morbidity associated with these more complex approaches [and] there is no evidence that these factors have been adequately considered" by surgeons performing the procedures, he wrote.