TREATMENTS YOU MAY OR NOT NEED

Certain medical procedures, although valuable, are commonly used inappropriately or too often. A recent report from the Lown Institute, a nonprofit that focuses on improving healthcare, found that during the pandemic year of 2020, adults on Medicare received 106,474 overused or unnecessary surgeries or procedures, meaning medical services that offer little to no clinical benefit or were more likely to harm patients than help them. It’s very easy for doctors and patients to go down the path of doing a medical procedure because it seems like, in theory, it would be safer and better, but that’s not always the case. More medical care isn’t necessarily always better, especially for older adults. Below we name three common examples:

SPINAL FUSION FOR LOW BACK PAIN

This surgery permanently connects two or more vertebrae in the spine—using metal plates, rods, or screws—to eliminate the motion between them that can cause pain. Spinal fusion is appropriate in situations such as a spinal fracture from a car accident, a severe bone infection, or a tumor that causes part of your spine to collapse. But generally, that’s not when it’s being done.

WHEN ITS QUESTIONABLE: Surgeons may advise spinal fusion for chronic lower back pain from severe arthritis or age-related wear from spinal disks. But studies suggest that under these circumstances, the procedure is no more effective than nonsurgical approaches such as physical, therapy (PT). If you have severe chronic back pain and have used measures like PT for six to 12 months without much improvement, however, consider asking your doctor about laminectomy, a procedure wherein part or all of the vertebral bone is removed to enlarge the spinal canal and ease pressure on your spinal cord, disks, and nerves.

STENTS FOR HEART DISEASE

This procedure props open a clogged coronary artery that carries blood to the heart muscle and then holds it open with a tiny sleeve (stent) that’s left in place. This is highly effective after a heart attack or for people with significant narrowing of certain major coronary arteries, especially ones that result in uncontrollable recurrent or severe chest pains.

WHEN IT’S QUESTIONABLE: If you have coronary artery disease (CAD), that is, plaque buildup in the walls of arteries that supply blood to the heart, but it’s stable, you’re unlikely to benefit. Stable means generally absent or minor chest pain or shortness of breath that occurs only with exercise or stress—and it resolves promptly with rest or medication. Most studies show that people with moderate or even severe but stable heart disease who took medication for it were no more at risk of a heart attack or death than those who had procedures like stenting. Note: If you have stable CAD but notice worsening symptoms—for example, they begin to occur even with minor activity when you’re at rest— talk to your doctor about more aggressive procedures, such as stenting or surgery.

VERTEBROPLASTY FOR OSTEOPOROSIS

Osteoporosis (bone softening) heightens the risk of painful compression fractures, bone breaks from “swashing” of the vertebrae. One way to treat them is vertebroplasty, where a surgeon injects special cement into the fractured area to support the spine and help to relieve pain. Some research suggests that it may offer benefits in the case of severe compression fractures, such as those significant enough to require opioid drugs to ease discomfort.

WHEN IT’S QUESTIONABLE: In most cases, vertebroplasty is no more effective at relieving compression fracture pain than a placebo, according to a 2018 review of multiple studies. It also noted that vertebroplasty has the potential to cause side effects such as spinal cord or nerve root compression, bone infection, and cement leaking into the bloodstream. That’s why, in general, this procedure isn’t recommended for mild to moderate pain that responds to pain relievers like acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). If you have osteoporosis, to prevent future vertebral fractures you should get plenty of calcium and vitamin D, avoid smoking, limit alcohol, and, when deemed appropriate by a physician, take osteoporosis medication.

CONCLUSIONS

Before undergoing any procedure, here are questions to consider for the doctor:

1. 1. If your parent had my condition, would you recommend this procedure?
   2. What happens if I wait? If putting surgery off or six months or more to see if your issue resolves won’t affect the outcome, waiting may be reasonable.
   3. What could go wrong if I have this procedure? You want to clearly know what the worst possible outcome could be. What are the chances of a fatal outcome?
   4. What alternatives are not quite as good but are still effective in my case? You want to know, for instance, if other appropriate options may be safer, less invasive, cause fewer side effects, or require less healing time.

Needless to say, active treatment isn’t necessarily better than conservative methods, or even merely waiting. When doubt exists, however, one should consider obtaining a second opinion from another qualified physician.