Today I came across the following article titled “The Spinal Surgeries That Didn’t Need to Happen — As much as half of all spinal fusions don’t alleviate pain — why do doctors perform so many?”, published in the Intelligencer section of New York Magazine.
The piece examines the growing phenomenon of spinal fusion surgeries in the United States and raises a troubling question: why are so many of these procedures performed when, in many cases, they fail to relieve pain? Through a detailed and humane narrative, the article explores how medicine, financial incentives, and patient desperation converge in a billion-dollar industry.
At the center of the story is Tiffany Bruce, an American woman who has lived with persistent lower back pain since the age of eighteen. It began during her pregnancy, and over the next two decades she underwent six spinal fusion surgeries, a procedure in which vertebrae are fixed with screws and metal plates. Despite the risks, Bruce kept believing that “the next one” would finally cure her. Instead, her pain worsened, she lost her job as a nurse, and fell into depression. Today, she finds support in a Facebook group for people living with chronic pain after spinal operations.
Bruce’s story is part of a broader national trend. Since the 1990s, the number of spinal fusion surgeries in the U.S. has multiplied, even though numerous studies have questioned their effectiveness in treating degenerative back pain. The United States now performs more of these surgeries than any other developed country—twice as many as Australia or Canada, and up to five times more than the United Kingdom.
One of the key points the article makes concerns the financial incentives built into the American healthcare system. Spinal surgery has become one of the most profitable specialties, and surgeons are paid according to a “relative value unit” (RVU) system that rewards complex procedures and the use of implants. The more hardware used, the greater the compensation. As a result, the spinal device market is now worth around 14 billion dollars a year.
The report also includes the voices of prominent surgeons who have criticized current practices. Eugene Carragee, former director of the Stanford Spine Center, and Jonathan Choi, who left the profession after speaking out about systemic abuses, both argue that many of these surgeries are performed without clear medical necessity. Carragee compares the situation to repairing a house without fixing the leak that caused the damage: surgery may rebuild the wall, but it does not solve the underlying problem. Both surgeons point out that many cases of back pain could be managed more effectively through physiotherapy, exercise, or lifestyle changes.
Another key issue the article discusses is the “failed back surgery syndrome” (FBSS)—a condition in which patients continue to experience pain even after multiple operations. In lumbar fusions, the failure rate can reach 50 percent, partly because immobilizing one section of the spine places extra strain on the adjacent segments, leading to further degeneration.
In the end, New York Magazine offers a critical and moving portrait of a system where medical hope, human suffering, and economic interests are deeply intertwined. Tiffany Bruce’s story illustrates not only the struggle of those seeking relief at any cost, but also the contradictions of an industry that has turned back pain into a thriving business.
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