It was reported by Zigler in 2011 that 200,000 spinal fusion surgeries are performed each year in the United States alone.1 An equal number of microdiscectomies are performed, according to Mayer (2006),2 and is considered by many to be a conservative number.Let's consider the chiropractic impact of exposing the public to treatment that could avoid needless surgeries, using the 400,000 disc surgeries as a conservative number, not to mention how this could reduce the unnecessary cost to government and private insurers and lost revenue to both government agencies and workers from absenteeism.
Allen, et al.,3 reported in 2010 that spine-related health care expenditures exceeded $97.5 billion (2011 inflation-adjusted), a 65 percent increase from 1997. With an aging population sure to experience increased biomechanical issues with age, this trend is sure to continue.
It was reported by McMorland, et al., in 2010 that more than 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low-back disc issues in the U.S.4 The researchers conducted a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disability between study groups.
This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI with associated radicular (nerve root) symptoms. Based upon the authors' review of available MRI studies, all study participants were initially considered surgical candidates.
Both the surgical and chiropractic groups reported that no new neurological problems surfaced and only minor post-treatment soreness occurred. Sixty percent of patients who received chiropractic care reported a successful outcome, while 40 percent required surgery; of those 40 percent, all reported successful outcomes. This study concluded that 60 percent of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery.
Let's do the math. If we take the 400,000 disc surgeries performed each year (adding cervical surgeries to the equation) and apply McMorland, et al.'s findings4 that 60 percent of surgical candidates had successful outcomes with chiropractic as an alternative to surgery, 240,000 patients could avoid needless surgery annually if they sought chiropractic care. According to Sherman, et al.,5 the 2010 inflation-adjusted amount per case in Medicare dollars is $13,243.82 per patient once you take into consideration the complications, but exclude many other variables such as repeated MRIs, myelograms, and many hospital charges. Allen, et al., taking into account total charges, including mean hospital charges for a single-level, uncomplicated, minimally invasive surgery, reported the cost to be $70,159 for all payors. They also reported that for two-level disc surgeries, the complication rate increased by 25 percent, with significantly higher costs.
If you consider 240,000 preventable surgeries at $70,159 per patient, that equates to $16, 838, 160,000 health care dollars that did not have to be spent. MEDSTAT, as reported by Chiropractic Lifecare of America (2009),6 estimated that the average cost of chiropractic care per patient per case is $3,918 (2011 inflation-adjusted dollars). If you take this amount and apply it to the 240,000 unnecessary surgeries, you have a net savings of $66,241 per patient. The net savings to the Medicare system and private insurers is $15,897,840,000.
According to Fayssoux, et al. (2010), who studied the indirect costs associated with surgery for low back pain, lost productivity related to absenteeism resulted in average lost wages of $2,884 per patient for the first postoperative year.7 "The findings demonstrate the significant, though not surprising, impact of spinal disability on productivity, and the importance of including measurement of lost productivity and return to work." This equals an additional $692,160,000 in wages to Americans per year by taking the necessity of absenteeism out of the equation (no surgeries to recover from).
Chiropractic offers solutions to the federal government, local governments, and public and private insurance companies by avoiding unnecessary surgeries. Chiropractic offers solutions to local, state and federal economies by increasing the tax base and productivity in the marketplace – by keeping workers at work and circulating money into local economies, with increased paychecks at the end of the year. The research is conclusive: Chiropractic has solutions to many of the economic and health care problems in the U.S. and worldwide.
- Zigler J. Lumbar artificial disc surgery for chronic back pain. Spine-Health.com. www.spine-health.com/treatment/artificial-disc-replacement/lumbar-artificial-disc-surgery-chronic-back-pain
- Mayer HM (editor). Minimally Invasive Spine Surgery: A Surgical Manual. Germany: Springer, 2006.
- Allen RT, Garfin SR. The economics of minimally invasive spine surgery: the value perspective. Spine, 2010;35(supp 26):375-82.
- McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 2010;33(8):576-584.
- Sherman J, Cauthen J, Schoenberg D, Burns M, Reaven NL, Griffith SL. Economic impact of improving outcomes of lumbar discectomy. The Spine Journal, 2010;10(2):108-116.
- Chiropractic Lifecare of America. (2009). The MEDSTAT Project. Learning. www.clahealthcare.com/learning/index.html
- Fayssoux R, Goldfarb NI, Vaccaro AR, Harrop J. Indirect costs associated with surgery for low back pain – a secondary analysis of clinical trial data. Population Health Management, 2010;13(1):9-13.
Dr. Mark Studin is a 1981 graduate of New York Chiropractic College. He is the co-founder and former executive director of the New York Chiropractic Council. Currently, he is president of CMCS Management. Contact Dr. Studin with questions and comments regarding this article at