tag:blogger.com,1999:blog-6193043695356712843.post4519301115412010432..comments2023-09-02T23:55:45.583+10:00Comments on Doctor Skeptic: Why does spine surgery increase impairment?Dr Skeptichttp://www.blogger.com/profile/09376469049519802493noreply@blogger.comBlogger16125tag:blogger.com,1999:blog-6193043695356712843.post-24072874258568322982018-02-23T11:24:53.245+11:002018-02-23T11:24:53.245+11:00I am not suggesting you do anything. I am saying t...I am not suggesting you do anything. I am saying that if surgery is meant to fix people, how come you are not fixed, and how come you need to have further surgery. You seem to think that the surgery is justified and has helped you? If so, why would your level of impairment increase after receiving such treatment. I have not found anybody who can explain how that makes any sense: how does improving your health make your impairment worse?Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-71469892610280139432018-02-22T18:19:07.576+11:002018-02-22T18:19:07.576+11:00Well I know where Janet Conard is coming from I wa...Well I know where Janet Conard is coming from I was a sussessful boilermaker before my injury to my lumbar spine I've currently had a decompression a inbody fusion of the L4 L5 and I'm about to have a posterior fusion of the L5 S1 and they will be revisiting my L4 L5 I had a very active life surfing, skiing, motorcycle riding I was a healthy 40 year old now I have to look at the rest of my life I'll probably never work again I'll never be able to interact with my children or grandchildren with in the sports that I love sure I've hurt my foot or corked my knee but it never stopped me from doing the things I love I could fight through the pain so you tell me should I sit back and be put on a pension for the rest of my life and maybe get a payout that I would of made myself within 5 years or so and that payout is supposed last me for the next 37 years so again tell me why you think I should be given nothing because I've had surgery?Anonymoushttps://www.blogger.com/profile/03483097013259784244noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-69066103514960007842017-07-03T22:30:25.038+10:002017-07-03T22:30:25.038+10:00it dependsit dependsDr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-57491738584727317122017-07-03T02:48:27.669+10:002017-07-03T02:48:27.669+10:00i have had c6and7 fusion 4 yrs ago seems ok with p...i have had c6and7 fusion 4 yrs ago seems ok with pain now i need an s1andl5 fusion and was told i will be on 40 pound restrickion for rest of my life im 51 years old havent worked for 12 months what my prognosisAnonymoushttps://www.blogger.com/profile/06138504917337203383noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-75545626121845926502017-04-20T11:30:52.043+10:002017-04-20T11:30:52.043+10:00Thanks, Interesting points. But I am not clear. Do...Thanks, Interesting points. But I am not clear. Does the spine surgery make the person's life better or worse? If it improves their life, why should their compensation / disabiltiy / impairment increase? If the surgery is ultimately detrimental to their health, why is being done? And remember, this is a very 'discretionary' area where surgeons vary greatly in their opinions on who should and should not get a fusion and on the effectiveness in this environment (compensation).Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-63728227103572724972017-04-19T21:53:29.019+10:002017-04-19T21:53:29.019+10:00With all due respect, your assessment of an actual...With all due respect, your assessment of an actual whole person impairment post cervicle spine surgery is simply ludicrous. Your assertion is that a person with a diagnosis in which fusion surgery is recommended is somehow "better" after having the invasive procedure. The procedure may or may not improve pain and or quality of life, but what it undoubtedly does is forever alter the persons cervicle spine in such a way that segments above and or below the segment fused cannot function within its normal range of motion without over pressure assuring the person of future fusion procedures. The cycle then repeats. <br /><br />Where I think your logic is mostly twisted is that you seem to be aligning your position with the fusion procedure's ability to somewhat alleviate pain symptoms to also improving the biomechanical aspects of the person's cervical spine. Neither are true. The spine is FOREVER altered and will, as a result, degenerate at an accelerated rate. So, to my point, the WPI is smartly increased with invasive surgery and that increase Is not directly related to any subsequent relief form said surgery, but takes into account the damaged person's future outcomes of which they cannot be and will not be compensated for. Anonymoushttps://www.blogger.com/profile/17686932191141653451noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-16934618594018930892017-01-28T13:48:05.799+11:002017-01-28T13:48:05.799+11:00Your point about me only focusing on money is wron...Your point about me only focusing on money is wrong. I rarely mention it in any posts. This one relates to impairment (which relates to compensation) but the outcomes I refer to are usually quality of life, pain, function and complications. These are the outcomes important to patients.<br /><br />My recurrent point is that people often get better (feel better, return to work, whatever) after ma y treatments for many conditions. We are not being scientific if we attribute every improvement to every treatment. So often, as highlighted in this blog, the APPARENT cause and effect association between treatment and outcome disappears on proper testing (e.g. comparison with placebo).<br /><br />My point in this post is different: according to the AMA5 impairment guidelines, your level of impairment (now that you have been treated and improved) is now much higher than when you had pain (pre-surgery), and that makes no sense at all.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-75800196610458136962017-01-28T12:11:00.100+11:002017-01-28T12:11:00.100+11:00I am a patient that recently had a two level fusio...I am a patient that recently had a two level fusion. You may be expert examiners but I think that you both need to walk a mile in a patient's shoes before writing your blogs. I know that although my surgery has greatly reduced my pain thatI have lost some mobility in my neck. I also know that my doctor informed me before surgery that I could end up having more surgeries in the near future.I have no received an inpairment rating yet. But is coming very soon. My point is I don't care about ratings. I care about this. Will I be able to return to my job as a CNA and safely do my job. That is my major concern. Too bad doctors and people like you only focus on money. No amount of money in this world is worth any disability that affects your life period. I was an extremely active person before my surgery. Now not as much. But I have not and will never as long as I breath give up trying to improve my quality of life.Janet Conardhttps://www.blogger.com/profile/16566576477465240928noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-23001277972100945942016-01-21T05:20:15.361+11:002016-01-21T05:20:15.361+11:00Argument from authority is a common argument form ...Argument from authority is a common argument form which CAN be fallacious, such as when an authority is cited on a topic outside their area of expertise, or when the authority cited is not a true expert. WikiAnonymoushttps://www.blogger.com/profile/12796245218427012668noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-83550574083756418522013-10-13T22:26:43.101+11:002013-10-13T22:26:43.101+11:00Thanks for the comment and link to your blog. Nice...Thanks for the comment and link to your blog. Nice to know that skepticism of doctors is not new. Good comment about the lack of financial interests in rational skepticism. I need a generous philanthropist to fund some of my research - one that can see beyond donating to the nearest research laboratory.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-35142190551049507272013-10-07T06:59:40.645+11:002013-10-07T06:59:40.645+11:00Thank you for your interesting blog. The rational...Thank you for your interesting blog. The rationalization of medicine seems to have diminished serious skepticism of medicine. As your blog highlights, that's rationally rather strange. The effect seems to me to be mainly institutional and discursive. Rational scepticism of medicine lacks institutionalized financial interests. It has also been discursively marginalized. Historically, anti-medical satire had a relatively high discursive profile. Some analysis:<br />http://purplemotes.net/2013/10/06/medieval-anti-medical-satire/<br />Douglas Galbihttps://www.blogger.com/profile/03138614768074771263noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-50867260368043821732013-10-03T09:45:09.224+10:002013-10-03T09:45:09.224+10:00This comment has been removed by a blog administrator.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-7299277391834986482013-09-29T13:20:05.377+10:002013-09-29T13:20:05.377+10:00Please see my response to you or someone similar o...Please see my response to you or someone similar on "Is back surgery just a placebo?" (http://doctorskeptic.blogspot.ae/2012/08/is-lumbar-spine-fusion-just-placebo.html).<br /><br />If you are writing about the ethics behind placebo surgery, you need to look at the literature, much of which is referred to in this blog, but all of which is easy to find. My qualifications are not relevant to the ethics, nor are they relevant to the validity of anything I say.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-58089702125584972242013-09-29T10:52:15.451+10:002013-09-29T10:52:15.451+10:00Hi Dr Skeptic,
I am currently writing a research ...Hi Dr Skeptic,<br /><br />I am currently writing a research paper on the ethics behind placebo surgeries and have found much valuable insight from your website however I do not know your actual credentials. I was wondering if you could respond so I can find them out and possibly use your insight in my paper!<br /><br />Thank you,<br /><br />Pharmacy Student Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-65868007045403814612013-09-23T19:38:44.488+10:002013-09-23T19:38:44.488+10:00Thanks for commenting John,
I did the course. I am...Thanks for commenting John,<br />I did the course. I am an AMA certified assessor. I checked the definitions. DRE IV (20-23% WPI) includes "may have complete or near complete loss of motion of a motion segment due to developmental fusion, or successful or unsuccessful attempt at surgical arthrodesis [fusion]".<br />I am not sure of the objection. It is very well known that a spinal fusion puts you into DRE group IV (20-23% WPI), but back pain without signs or instability puts you into DRE group I (0%WPI). It is often raised as an issue from insurers that spine fusion surgery increases their costs because of this very classification system.<br />I will grant you that I should have said "loss of motion of a motion segment" rather than "loss of motion segment integrity". I have now changed it but wording aside, this does not change the primary problem that spine fusion for back pain puts you into an increased impairment category.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-14511225632128751392013-09-23T09:03:43.382+10:002013-09-23T09:03:43.382+10:00Hi Doc S.
I suspect in your haste to find fault wi...Hi Doc S.<br />I suspect in your haste to find fault with spinal surgery (again) you may have misinterpreted the definition of "loss of motion segment integrity" from the AMA guides.<br />I refer here to the 4th edition as used in my home state of Victoria, and most other states of Australia, utilising the Diagnosis Related Estimates (DRE) model of assessment, again, as used throughout Australia. Page 98, under the heading "Loss of Motion Segment Integrity", defines the term using several paragraphs that describe not a spinal fusion, but instability - that is, increased motion at a spinal level, as may happen following a traumatic spinal injury.<br />Table 72 on page 110, "Lumbosacral Spine Impairment Categories", where you probably obtained the 20% WPI, also quite clearly refers the reader to the same section of the book I have just described. It's a shame you didn't check your definitions.<br />The only table that refers to postoperative status is Table 75, which is part of the Range of Motion Model (not used in Australia), where a single level fusion, even with residual signs, is given 12% WPI. Again, that system isn't used in Australia.<br />As an AMA certified impairment assessor, I had to complete a course on how to use the AMA guides in order to understand them and be familiar with them. It's a shame you've written this blog post clearly without having completed the same course, or even checking your definitions.<br />John<br />John Cunninghamhttp://www.cunningham.com.aunoreply@blogger.com