ArticleSurgical neurology international2013
Are recommended spine operations either unnecessary or too complex? Evidence from second opinions.
Article in Surgical neurology international, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed.
- In-network multidisciplinary digital care improves outcomes in medicare advantage members with musculoskeletal diagnoses.Frontiers in digital health · 2026Article
- The four-eye principle in preoperative indication for lumbar spine surgery: A retrospective cohort analysis with prospective follow-up.Brain & spine · 2026Article
- Article
- [Second opinion on spine surgery : Indication rarely confirmed and conservative treatment options are worthwhile].Schmerz (Berlin, Germany) · 2023Article
- Unnecessary Cervical Discectomy - A simple test to differentiate between Cervical and Shoulder Pathology: A Case Report.Journal of orthopaedic case reports · 2022Article
- Second opinions for spinal surgery: a scoping review.BMC health services research · 2022Article
- Clinical outcome analysis in surgical patients enrolled in a Second Opinion Program in spine surgery.Einstein (Sao Paulo, Brazil) · 2022Observational
- Second opinion in spine surgery: A scoping review.Surgical neurology international · 2021Article
- Perspective on robotic spine surgery: Who's doing the thinking?Surgical neurology international · 2021Review
- COVID-19 Provides An Opportunity to Reassess How Frequent and How Extensive Elective Spine Surgery Should Be.Surgical neurology international · 2020Article
- What Can Spine Surgeons Do to Improve Patient Care and Avoid Medical Negligence Suits?Surgical neurology international · 2020Article
- The market landscape of online second opinion services for spine surgery.Surgical neurology international · 2020Article
- Why I testify for some patients/plaintiffs, and against some doctors/defendants.Surgical neurology international · 2018Article
- Impact of acupuncture treatment on the lumbar surgery rate for low back pain in Korea: A nationwide matched retrospective cohort study.PloS one · 2018Article
- Second opinion for degenerative spinal conditions: an option or a necessity? A prospective observational study.BMC musculoskeletal disorders · 2017Observational
- Lumbar stenosis surgery: Spine surgeons not insurance companies should decide when enough is better than too much.Surgical neurology international · 2017Article
- Second opinion in spine surgery: a Brazilian perspective.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2015Article
- Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review.Anesthesiology and pain medicine · 2015Review
- RE: The risks of epidural and transforaminal steroid injections in the spine: Commentary and a comprehensive review of the literature.Surgical neurology international · 2014Article
- The death of spine surgery, sequel - 2014.Surgical neurology international · 2014Article
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No grant is acknowledged in the PubMed record.
Abstract
backgroundIn 2011, Epstein and Hood documented that 17.2% of 274 patients with cervical/lumbar complaints seen in first or second opinion over one year were told they needed "unnecessary" spine surgery (e.g., defined as for pain alone, without neurological deficits, or significant radiographic abnormalities). Subsequently, in 2012 Gamache found that 69 (44.5%) of the 155 second opinion patients seen over a 14-month period were told by outside spine surgeons that they needed surgery; the second opinion surgeon (Gamache) found those operations to be unnecessary. Increasingly, patients, spine surgeons, hospitals, and insurance carriers should not only be questioning whether spinal operations are "unnecessary", but also whether they are "wrong" (e.g., overly extensive, anterior vs. posterior operations), or "right" (appropriate).
methodsProspectively, 437 patients with cervical or lumbar complaints were seen in spinal consultation over a 20-month period. Of the 254 (58.1%) patients coming in for first opinions those with surgical vs. non-surgical lesions were identified. Of the 183 (41.9%) patients coming in for second opinions, who were previously told by outside surgeons that they needed spine operations, the second opinion surgeon documented the number of "unnecessary", "wrong", or "right" operations previously recommended.
resultsSurgical pathology was identified in 138 (54.3%) patients presenting for first opinions. For patients seen in second opinion, 111 (60.7%) were told by outside surgeons that they required "unnecessary", 61 (33.3%) the "wrong", or 11 (6%) the "right" operations.
conclusionsOf 183 second opinions seen over 20 months, the second opinion surgeon documented that previous spine surgeons recommended "unnecessary" (60.7%), the "wrong" (33.3%), or the "right" (6%) operations.
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