This paper explains the history of how spinal fusions and minimally invasive surgeries came to be. It is explained how quality of care and the effectiveness of spinal operations have evolved. The governmental role is explained regarding the financing of these surgeries. Medicare and Medicaid is explained and how it comes into play for low income and elderly patients. Quality of Healthcare plays a crucial role for recovery in surgical patients. One of the most important things discussed is the medical advancements that are giving people the opportunity to receive new types of treatments in a less invasive manner.
Introduction
Advancements in surgical techniques and medical equipment have helped give spinal surgeries a positive outlook in the recent years. Society’s recent medical advancements are providing individuals with treatments and cures for various previously untreatable diseases and conditions. The evolving history of microscopic procedures show us one way in which medical advancements have changed the quality of human life. Government funding such a Medicare and Medicaid are giving patients the ability to receive the care that they need. Back pain is the 9th most expensive condition treated in the United States (Schoen C, 2007).
The healing process has been cut in half in comparison to what it was in 1970 while increasing the effectiveness of operations (Foley K, 2016). Men and woman with spinal deformities such a scoliosis, spondylolisthesis and degenerative disc disease are being given more options for surgery rather then just the traditional open procedure. These new advances in spinal operations are providing the chance for patients to have minimally invasive procedures that make spinal fusions and herniated disc repair easier.
History of Spinal Surgery
Health care is constantly evolving as we make changes to our health care system. However, the same concepts have been observed for decades. In 1970 a spinal fusion required 6-9 months of bed rest after an operation, with an average hospital stay of 1 year, significant rates of fusion failure, infection and loss of correction (Matthew Tann, 2010). Many surgeons were looking at other less invasive ways to fuse the spine. 1955 marked a milestone in scoliosis surgery when Paul Harrington developed the Harrington distraction instrumentation, which straightened the spine by holding it taught while a fusion took place. The original procedure was a steel rod on a ratchet system attached to the spine with hooks at the top and bottom of the curvature that would distract the curve when cranked (Clayton Alonso, 2010). Harrington’s method did fail; however, it has lead us to the advancements we see today.
Effectiveness of Surgery
Many new medical procedures are now being performed with fiber optics technology and can help eliminate painful surgery techniques. Untreatable conditions are now becoming treatable and it is increasing the quality of life in millions of people. Numerous types of spine abnormalities like scoliosis, spondylolisthesis and lordosis are being now treated successfully with the help of this advanced technology. Spondylolisthesis is an abnormality of the lumbar spine that has a defect in the pars causing a posterior or anterior slippage, usually requiring a spinal fusion. Spinal fusions are becoming less invasive due to microscopic surgery and minimally invasive surgery. Minimally invasive surgery is performed through small incisions less than 1 inch in diameter, or with puncture sites. However, this can be misleading because minimally invasive surgeries can be any length. Traditional surgical methods for intricate operations require incisions from six to ten inches long (Peter F. Ullrich, 2016). An endoscope, which is a thin, lighted tube with an attached camera and surgical instruments are passed through these tiny incisions (AANS, 2016). The endoscope enables the surgeon to view the problem area without having to make a large incision. the surgeon can safely work on the spine without harming normal tissue. Because of this, patients are less likely to develop infections, have a smoother recovery, and can return to normal activities quicker than the traditional approach. When having a minimally invasive surgery you can usually go home on the same day, as these types of surgeries are typically outpatient procedures. Ninety-five percent of the patients report excellent pain relief after microsurgery (Foley K, 2016). Studies have proven that these procedures are safe, very successful, and cost effective. After having a spinal fusion in the 1970’s, it used to take at least one year to feel back to normal, now many people within two weeks are feeling quite a bit better (Matthew Tann, 2010).
Quality of Care
Doctors are now able to cure many previously incurable conditions and provide his or her patients with a normal life and with a higher quality of care. Problems that some spinal fusion candidates face is that some surgeons are doing these surgeries for the wrong reasons, a spinal fusion today of the L5-S1 can cost up to $169,000. In some cases, a spinal fusion is not always the correct answer when trying to relieve a patient’s pain, which is what some surgeons overlook. If a patient was to have a grade 1 slippage of the L5-S1, a surgeon typically would not want to operate until all measures have been taken to find pain relief. A nerve block has become a good way to find the source of a patient’s pain, it is typically prescribed to a patient of this type and if it helps, then the root cause would be known as the slippage (O’Leary P.T, 2016). However, if this nerve block does not help then another can be prescribed in a different area. A nerve block can be given up to 3 times per year because the procedure consists of injecting a numbing agent into the spinal column, if done too frequently a spine can become weak and have early signs of osteoporosis (AANS, 2016). If a numbing agent does not work for the patient, then a fusion would be recommended. Early on in the 1950s when we had no way of identifying what was painful and what was not, it was routine just to fuse the bottom two levels and hope the pain would go away (Clayton Alanso, 2010). Now we have nerve blocks, MRI scans, CT scans, X-Rays and bone scans to help narrow down the root of pain.
Financing Spinal Surgery
Many people are faced with the burden of medical bills and trying to understand the language of the health care industry. It can be overwhelming for patients when a very serious and stressful situation arises with their health. Medicare and Medicaid are two helpful government programs that help aid the coverage for life changing surgeries such as a spinal fusion or a laminectomy. Medicare is a program that will provide health coverage to individuals who are 65 years of age or older. It will also give health coverage to those who suffer from a severe disability no matter the amount of income. Medicaid is a federal program that is state administered. The Medicaid program gives health coverage to those who have an extremely low income. These government plans help to alleviate stress caused by financial burdens. An anterior cervical fusion can range from $19,850 to $44,000. Whereas Lumbar spinal fusions can cost $34,500, however when you add in hospital costs, anesthesiologist costs and medications is can reach up to $169,000. A problem that arises from such astronomical costs is the benefit for the doctors themselves. More than 90% of back fusions, disc repairs and spinal injections are unnecessary and ineffective (Smith, J, 2016). With more than 90 percent of operations being ineffective gives back surgery a bad reputation. This is a significant problem when trying to decide to go though an operation that may or may not help. Medicare or Medicaid can be a lifesaver for those with low income or a severe disability and cannot afford to get the access to health care that he or she needs. The problem with these government programs is that patients can still be left with a hefty bill. Medicaid will cover the initial surgery. However, post operative procedure are more than likely not covered. With something like a spinal fusion this can be a significant issue because post operative procedures are where most of the expenses come from. Resulting in a lack of funds causing stress on the patient which could interfere with the healing process. When deciding to go through with an operation, it is pertinent that clients do research on what his or her insurance plan covers and what out of pocket expenses they may have to pay. Having a quality health insurance is essential for patients who wish to receive a high quality of care.
Conclusion
Back pain is one of the most expensive conditions to be treated in the United States. The recent advancements in surgical techniques and medical equipment has allowed patients to recover faster and return to a normal life style, increasing his or her quality of life. Financing a spinal surgery can be a burden however there are resources available to help patients receive the care that they need. The health care field will continue to grow as technology evolves which will allow doctors to increase their quality of care. As the government, insurance companies and hospitals all work together we will continue to see an improvement to the United Stares health care system. Spinal surgeries will continue to improve and soon set a new standard for surgical success. From something as small as stitches to a complete spinal fusion, modern medical advancements have revolutionized the quality and longevity of lives.