Unnecessary Back Surgery-The Hidden Costs

Unnecessary back surgery happens more than most realize.

Back pain is a common and even disabling condition. And when conservative treatments don’t seem to help, patients can feel pressured to consider surgical interventions. But what if a significant number of back surgeries performed aren’t medically necessary?  And worse, expose patients to risk, expense, and potential injury? That is the alarming conclusion of a recent analysis by the Lown Institute and backed up by additional medical-legal research.

At The Law Offices of David L. Hood, we believe in empowering patients with knowledge. This post will:

• examine the Lown Institute’s findings
• explore why unnecessary back surgeries happen
• discuss the legal implications of surgical error or negligence
• and offer guidance for patients who believe they were harmed by improper surgical practices.

Unnecessary Back Surgery in the U.S.

In its report Unnecessary Back Surgery — 2025, the Lown Institute (via the Lown Hospitals Index) analyzed Medicare and Medicare Advantage claims to identify unnecessary or inappropriate spinal procedures. Their key findings include:

• Over a three-year period, U.S. hospitals performed more than 200,000 back surgeries on older adults that met criteria for overuse.
• These procedures cost Medicare approximately $2 billion over the same timeframe. That’s roughly $600 million per year.
• On average, 14% of spinal fusions and laminectomies were flagged as potentially unnecessary. Overuse rates varied dramatically by hospital (ranging from less than 1% to more than 50%).
• Unnecessary vertebroplasty (injections to treat vertebral fractures) was also common. About 11% of visits for osteoporotic fractures triggered vertebroplasty procedures that lacked clear indication.
• The study also identified significant variation by geography and hospital systems. States like New Hampshire, Iowa, Massachusetts, and Pennsylvania had spinal surgery overuse rates exceeding 18%. In South Carolina, the highest rate of unnecessary surgeries were performed at McLeod Regional Medical Center (16.2%).

Put another way, the Lown Institute concluded that every eight minutes, an older adult in the United States receives an unnecessary back surgery. They fail to meet evidence-based criteria for necessity.

Why Does Unnecessary Back Surgery Happen?

The Lown Institute and other analysts propose several drivers behind this phenomenon:

• Variation in practice culture: Local norms, training, and institutional habits influence whether surgery is recommended — even when the clinical justification is weak.
• Financial incentives: In fee-for-service systems, surgeons and hospitals may earn more from performing procedures than from conservative care. Device manufacturers also have financial relationships with surgeons (speaker fees, consultancy, etc.). Beckersspine.com
• Defensive medicine: Fear of litigation may push surgeons to “do something” rather than risk under-treatment, even when surgery is not strongly indicated.
• Patient expectations and pressure: Patients often believe that surgery is the definitive path to cure pain, even when nonoperative options (like physical therapy, lifestyle modification or acupuncture) might be safer.
• Weak guideline adherence and care persistence: No clinical benefit imaging, injections, and surgeries remain common in spinal care. This trend is documented in multiple studies and highlighted by the Lown Institute’s work on low-back pain. Lowninstitute.org
• Clinical Risks & the Reality of “Failed Back Surgery”

When a surgery is unnecessary or poorly performed, patients may suffer serious harm. A well-known consequence is Failed Back Surgery Syndrome (FBSS) — a condition where pain persists (or worsens) after spinal surgery.

Other risks include:

• Neurological injury (nerve damage, paralysis)
• Infection or hardware (implant) complications
• Need for revision surgery ( which carries its own added risks )
• Worsening disability, chronic pain, depression, and reduced quality of life
• Death

Because these interventions remove or alter natural structures, when done incorrectly or unnecessarily, they can create more harm than benefit.

Legal Implications: When Surgery Crosses into Negligence or Malpractice

The line between an unfortunate but accepted surgical risk and a legally actionable wrong is a complex one. However, many judicial and medical studies indicate that spine surgery is among the most litigious medical fields.

Frequency and Outcomes of Spine Surgery Litigation

• Neurosurgery (including spine surgery) faces higher malpractice claim rates than many medical specialties. Alliedworldinsurance.com
• A review of spine surgery malpractice found that plaintiffs’ verdicts occurred in 17% to 35% of cases, and settlements in 8% to 37%. PMC
• In malpractice suits involving spine surgery, the most common bases are:
  1. Failure to timely diagnose or treat
  2. Surgical negligence (errors in performance)
  3. Lack of informed consent (failure to explain risks, benefits, alternatives)
• In a case series of U.S. spine surgery malpractice claims, pain was the most frequently alleged indication, while lumbar fusions were the most common procedure implicated. PMC
• One recent summary found that in many spine malpractice claims, failure to obtain proper informed consent was explicitly cited (e.g., failure to explain alternatives and risks) were often a component in non-consent related claims. JAMANetwork.com

These statistics underscore that while many spine surgeries proceed without incident, a large proportion lead to litigated outcomes — particularly when surgical judgment, consent, or technique is flawed.

Key Legal Red Flags in Spine Surgery Cases

If you or someone you care about has undergone spinal surgery and experienced a poor outcome, some red flags suggesting possible malpractice include:

1. Lack of clear preoperative justification — Did the surgeon document objective imaging and correlate that to symptoms?
2. Insufficient discussion of nonoperative alternatives — Was physical therapy, pain management, or other conservative care fully explored?
3. Failure to disclose risks and benefits — Especially the risk of persistent pain, nerve injury, and need for possible revision surgery.
4. Deviation from standard of care techniques — Wrong-level surgery, instrumentation errors, fusion across inappropriate segments, or incorrect surgical plan.
5. Poor postoperative follow-up or delayed recognition of complications
6. New or exacerbated neurological deficits
7. Death

Whether any case has merit depends on careful review of the medical record, imaging, surgical planning, and expert testimony.

What Patients (and Their Advocates) Can Do

Before Surgery: Be an Informed Consumer

• Request a complete discussion of nonoperative alternatives
• Ask about surgeon experience and volume — high-volume, board-certified spine surgeons typically have lower complication rates
• Seek a second opinion (ideally from a spine specialist who is independent)
• Ask the surgeon to explain the justification for the specific surgical plan (why fusion, why that level, why instrumentation)
• Ensure you receive a detailed informed consent document that includes risks, alternatives, and a realistic prognosis
• Get that second opinion!

After Surgery: Monitor and Advocate

• Keep detailed records of pre- and postoperative symptoms, imaging, pictures and follow-up reports
• If things go poorly, ask for a postoperative review or consultation
• If you suspect malpractice, seek a qualified medical malpractice attorney (like our firm and our co-counsel legal team) and have a specialist evaluate your records

Policy & Systemic Reforms: What the Lown Institute Recommends

To curb overuse and protect patients, the Lown Institute suggests reforms such as:

1. Better peer-review and oversight of hospital surgery performance
2. Public reporting of overuse metrics
3. Strengthening incentives to favor nonoperative care where evidence is lacking
4. Reducing physician conflicts of interest, particularly between device manufacturers and surgeons
5. Clinical guidelines and decision support tools to limit low-value procedures.

These reforms aim to shift the system away from reactive surgery-first models toward patient-centered, evidence-based decision-making.

The Lown Institute’s groundbreaking analysis shows that unnecessary back surgery is a pervasive and costly problem — not just to Medicare, but to patients’ health and quality of life. With over 200,000 flagged procedures and $2 billion in waste, this is not an isolated issue but a systemic one.

Why a Medical Malpractice Law Firm Like The Law Offices of David L. Hood Matters in These Cases

When surgery is unnecessary or negligent, the consequences for patients can be lifelong. As experienced medical malpractice attorneys, Attorney David Hood and our co-counsel legal team can help you:

• Secure independent expert review of your medical record
• Identify surgical deviations and errors
• Assess liability of surgeons, hospitals, and device manufacturers
• Pursue compensation for medical bills, lost wages, pain & suffering, and long-term care needs

Our goal is twofold: justice for injured patients and discouraging negligent practices in the future.

If you or a loved one has undergone back surgery and experienced disappointing or harmful results, you don’t have to accept that outcome. Contact The Law Offices of David L. Hood for a no-obligation consultation. We can help you understand if malpractice may have played a role and guide you toward accountability. To get in touch with us, chat, text, email, or call today!

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