Friday, July 01, 2011

Who's Got Your Back? (Spinal Health)

Backs and spines are on my mind. It always gets me when I read about therapies that really don't work that well, but doctors and hospitals keep talking them up and advertising them. In the past week, I've gotten a glossy marketing piece from Greenwich Hospital extolling the virtues of spine surgery, spinal fusion and bone growth; read an article in the New York Times by Jane Brody on spinal fractures and caring for your back; and read a New York Times business section article on spine specialists repudiating Medtronic's bone growth product primarily used in spinal fusions. "Spine Experts Repudiate Medtronic Studies".

My conclusion from all this is that my mother was right. Avoid surgery. Be wary of doctors who are looking to make money from expensive procedures. Don't twist. Don't do stomach crunches. Don't do bending and touching your toes exercises. Lift things carefully and properly. I also have listened to my primary care physician who gave me back-strengthening exercises similar to ones written up by Jane Brody. 

As Ms. Brody points out, vertebrae can just crumble from compression when you have weakened bones. And two out of five women over 80 have had such fractures. Half of the 1.5 million fractures due to bone loss are fractures of the vertebrae. Sometimes, you don't even know you've had the fracture, which can occur even if you don't have osteoporosis. The columns says that bone strengthening medicine, calcium and vitamin D can help prevent the breaks, however. And experts warn that you should not rush into invasive procedures like bone fusing or bone strengthening. These procedures are risky and may not have much benefit.

The business section article about Medtronic's product backs up Ms. Brody's column. It tells how an issue of The Spine Journal was devoted to the topics of bias and conflicts of interest in corporate medical research and sponsorship of scientific studies. The articles singled out Medtronic's Infuse, which is used in 25% of the 423,000 spinal fusions performed in the U.S. annually. Questions of morality and public safety are at the core of The Spine Journal's investigative journalism, questioning Medtronic's research as to the effectiveness and the safety of Infuse. Medtronic makes about $900 million a year from sales of Infuse. (And you wonder why our health care system and Medicare costs are out of control.) The entire article is well worth reading and goes into far more expert detail than I can. If you or a loved one has back problems, I commend all these pieces to you.

1 comment:

Anonymous said...

I read your blog with considerable interest. I'd like to comment on an article you referenced. Reading Jane Brody's article, she doesn't specify how high one goes in doing a "crunch" exercise in her " Avoid Crunches" article. Jane is famous for giving some good advice, that applies to some folks some of the time, but should never be considered "gospel" for all folks, all the time. ( Her famous NYT shoulder injury/ rotator cuff articles and exercises: and her later modifications of the exercises shown, in a subsequent NYT article in the 1980's, point this out.)

Smartly applied modified crunches are invaluable for many who suffer back pain, young and old alike. Her mentioned pelvic tilt exercise yes, is very valuable, but in and of itself, is not adequate for a moderately "in shape" or relatively active individual. Other aspects of her advice in that mentioned article, can be very counter productive to large segments of the aging population. For example, the sitting and crossing one's legs to put on a shoe is initially HIGHLY contraindicated, and the positioning need be avoided for the new or relatively new Total Hip patient. Also, walking with a fully upright, erect posture, chin tucked in and head back, can produce significant spinal stenosis pain for those seniors with that relatively common condition related to an aging spine. If the pain causes one to limit their walking, that can prove disastrous. It is far more important for the bone growth aspects of weight bearing, and anti-osteoporosis considerations, that one be on their feet and moving. Pushing a shopping cart in the slightly bent forward posture, in the super market, can greatly increase the spinal stenosis patient's ability to be weight bearing, and their tolerance of walking and moving. Such a position, will not compromise the spine, causing pain that would limit one's walking.

Thank you for the blog. Other aspects of your article and observations are excellent.

Jim Rumsey, PT