Articles by JCS

Marketing Pain: Part 2

Marketing Pain: Part Two

Minimally Invasive Surgery

Quick Fix or Quick Con?

Undoubtedly the largest advertising ploy today disseminating misconceptions about LBP treatments are the incessant TV ads promoting “minimally-invasive” laser spine surgery (MISS) by the Laser Spine Institute (LSI). Similar versions of MISS are also now seen in Australia and the UK.

These MISS TV ads clearly illustrate how the Lancet panel’s Key Message of “widespread misconceptions in the population” that have reinforced in the public’s mind the debunked concept of ‘bad discs’ as the main cause of LBP as well as promoting laser spine surgery as a quick-fix. In fact for the majority of patients, neither is true.

Without being too technical, experts suggest only 10-15% of LBP problems are pathoanatomical issues (‘bad discs’, cancers, fractures, infections, cauda equina or serious neurological problems) that require surgery. However, 80-90% of LBP cases are pathophysiological problems (joint dysfunction, segmental buckling, soft tissue issues, muscular spasms, etc.) that respond best to hands-on care such as SMT, massage therapy, CBT and home exercises.

Quick Con

Instead of this message, the public is now inundated with LSI ads touting its high-tech laser as a quick fix of most all LBP cases, but its only real advantage seems to be vaporizing the laceration minimizes blood loss. Otherwise it is based on the debunked ‘bad disc’ theory.

Actually many experts now believe MISS is not an improvement over “open” surgery and admit laser surgery is not for most spine problems, but one thing is for certain — these TV ads are quite convincing and profitable via constant marketing of a “laser” quick fix.

The idea of immediately leaving a surgery center pain-free with only a small bandage on your back certainly sounds appealing but, in reality, this image of a quick fix with laser spine surgery constitutes the newest “widespread misconception” in LBP.

In the recent Lancet review, Low back pain: a call for action - The Lancet, the panelists addressed such misconceptions:

Other barriers to optimal evidence-based management include widespread misconceptions of the general public and health professionals about the causes and prognosis of low back pain and the effectiveness of different treatments, fragmented and outdated models of care, and the widespread use of ineffective and harmful care, particularly in countries regarded as models of high quality care.

Of course at the top of the list of “widespread use of ineffective and harmful care” stands spine surgery. These LSI ads perpetuate an “outdated model of care” because they are misleading on many levels.

In fact, the actual use of laser surgery is minimal in most spine surgery cases according to Michael Steinmetz, MD, Co-Director of Cleveland Clinic’s Center for Spine Health, who says he rarely uses a laser for people with degenerative spine disease. However, he does use them for:

·        Removing tumors from the spinal cord

·        Removing bone or soft tissue around a nerve

·        Shrinking disc material around a nerve

“In a standard practice, only about 30 percent of surgeries are appropriate for minimally invasive procedures, and that may not always involve using a laser,” he says.

Dr. Steinmetz explained the difference between open and laser surgery:

In the traditional approach to spinal surgery, the surgeon’s incision goes through the skin to the muscle. To get to the tissue or other problem area, the surgeon dissects the muscles away from the spine. This can damage the surrounding soft tissue, causing pain, blood loss and longer hospital stay for recovery.

An alternative to traditional “open” spine surgery is a minimally invasive procedure. Here, the surgeon makes a smaller incision and uses a tool to tunnel to the site of the pain. Because the muscles aren’t pulled away, damage to the surrounding area is minimal and the recovery time is often shorter.

Appealing Ads

Most people are justifiably scared of spine surgery since they know friends and family members with failed back surgery. To address the fear of spine surgery, one Laser Spine TV ad, “Hear the Truth,” promotes the Trust Factor (perhaps chiropractic should learn a lesson from this):

Although 75,000+ patients since 2005 may seem like a lot to an audience of laymen, I daresay chiropractors have had many more satisfied patients in the same time frame. Let’s crunch the numbers.

The American Chiropractic Association estimates doctors of chiropractic treat more than 30 million people annually; in the same time span of 13 years, this equates to 390,000,000 patients. At a rate of 90% satisfaction rate (in fact, one study found 95.5% of patients would definitely recommend chiropractic), this equates to 351,000,000 happy patients.

Plus, chiropractic is less than minimally but totally noninvasive.

Voodoo Diagnosis

Without question, these MISS laser ads are perpetuating “widespread misconceptions” of the debunked ‘bad disc’ concept by luring naïve patients with the bait-and-hook offer to “Call for Your No-Cost MRI Review.” (BTW: if you look closely at this LSI ad, in the top row of images are not MRIs but radiographs.)

As patients’ complaints have revealed, when they call for a “no-cost MRI review” they are screened by a “bird dog” telemarketer who first checks for insurance coverage and reportedly quotes prices before the patient is even consulted or examined by an MD. If they don’t fall for this sales pitch, they can expect strong-arm follow-up calls at these surgery mills.

Apparently in many cases the free MRI review actually costs $250 to get first through the door. Then begins the sales pitch by the MISS surgeons at the MRI review: “Look right here and you can these ‘bad discs,’ so you need surgery.” Since the public has already bought into the ‘bad disc’ concept, this is an easy sale — a picture’s worth thousands of dollars to these surgical scammers.

What goes unmentioned in these MRI reviews is the fact 80% of asymptomatic 50-year-olds will show signs of DDD and 60% will have a disc bulge as confirmed by the Mayo Clinic.

The Mayo Clinic review found ‘bad discs’ were as common as grey hair in the natural aging process, highly prevalent in people of all ages, and did not alone constitute the need for surgery or needle jockeys doing ESIs or other spine interventions:

“Our study suggests that imaging findings of degenerative changes such as disc degeneration, disc signal loss, disc height loss, disc protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention.”

The recent Lancet review also mentions this MRI scam:

…the development of new technologies [such as laser spine surgery], will probably exacerbate this problem. For example, the use of increasingly sensitive imaging techniques, such as MRI, can reveal findings that might be incorrectly inferred to be the cause of a patient’s symptoms.

It’s past time to reveal this scam rather than sitting idly by without comment as the public continues to be ripped off!

The chiropractic profession could not have paid enough to the Mayo Clinic or the Lancet reviewers for such credible evidence of the debunked ‘bad disc’ ploy.

Remarkably, both the ACA and F4CP have said nothing about this ‘bad disc’ con-job.

Isn’t it our duty as a public service to reveal this ‘bad disc’ scam just as the opioid scourge was finally exposed? Imagine the millions of unsuspecting patients who were conned into spine surgery on this ‘bad disc’ falsehood who we could have helped.

I seriously doubt most spine surgeons make no mention these ‘bad discs’ are ubiquitous in many pain-free people; nor do they reveal for years these ‘bad discs’ have been dubbed ‘incidentalomas’ by many spine experts since they are incidental to back pain.

“An MRI is unlike any other imaging tool we use,” Dr. Bruce Sangeorzan said. “It is a very sensitive tool, but it is not very specific. That’s the problem… scans almost always find something abnormal, although most abnormalities are of no consequence.”

The Lancet review also mentioned this point:

Many  imaging  (radiography,  CT  scan, and MRI) findings identified in people with low back pain are also common in people without such pain, and their importance  in  diagnosis  is  a  source  of  much  debate.

Certainly the deceptive Laser Spine Institute ads demonstrate The Lancet panel’s message of “widespread misconceptions” since ‘bad discs’ are used by MDs as a sales-pitch to convince naïve patients in pain of the need for spinal surgeries that are most likely unnecessary.

 

Aside from the ‘bulging/herniated discs’ ploy, this ad is also misleading in other ways: how can a laser correct scoliosis, stenosis or “other chronic conditions”? This overreach may bring in new clients with high hopes for a quick fix, but it is certainly a bait-and-switch situation leading to false hope and poor outcomes.

I suspect nor does the LSI or any spine surgeon recommend chiro care before surgery despite the endorsement by the North American Spine Society. In 2012, the NASS published Clinical Guidelines for Multidisciplinary Spine Care Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy that found:

“...patients with lumbar radiculopathy due to lumbar disc herniation, 60% will benefit  from  spinal  manipulation  to  the  same  degree  as  if  they  undergo surgical intervention. For the 40% that are unsatisfied, surgery provides an excellent outcome.”

Do you think the Laser surgeons inform their patients with herniated discs that the North American Spine Society recommends SMT before surgery? Okay, stop laughing!

Band-Aid Solution

Undoubtedly another deception with laser surgery is the band-aid solution. There is no doubt these laser ads are effective attracting prospective clients with unfounded promises of a quick fix as one disgruntled patient wrote “…just like the LSI commercial shows - you walk away ‘fixed’. Not so - there is definitely post-surgery recovery involved!! I now have debilitating PTSD, in large part from dealing with the intractable head and face pain.”

 

One rather deceptive Laser Surgery ad depicts a middle-aged man in pain while his pitiful dog earnestly holds a leash in its mouth begging for a walk. In the next scene after the surgery, the man is jogging with his happy pooch. No rehab, no disability, no side effects, just an instant cure and everybody, including the dog, is happy!

Reaping Profits & Complaints

And the happiest of all are the owners of laser surgery clinics.

Such hyperbolic TV ads have not gone unnoticed by a National Public Radio broadcast revealing in its investigation, Laser Back Surgery Clinics Reap Profits, Complaints:

“The surgery to relieve back pain hasn't been shown superior to laser-less versions and runs about $30,000, more than twice the amount insurer Aetna will pay for the old-fashioned approaches… One neurosurgeon who has treated former Laser Spine patients said, "It strikes me as somewhat of a scam.”

Bloomberg News reported that one laser surgery clinic had an annual profit margin of 34.3 percent from 2006 through 2009, higher than that of Google at 24.8 percent. One insurer paid Laser Spine $90,176 for an operation, a follow-up procedure, and some subsequent care. Laser Spine’s surgeons, some of whom are investors in the company, perform as many as 5,000 operations a year,[1] which equates in a 50 working week year to be 20 surgeries daily. No wonder the Laser Spine Institute in Tampa employs 600 people!

The Laser Myth in Spine Surgery

Not only does Laser Spine Institute look shady, many prominent spine surgeons also cast criticism. Mark R. McLaughlin, MD, FACS, FAANS, was adamant about the myth of laser surgery when asked, “Do you use a laser in your spinal surgeries?”

That question makes the hair stand up on the back of my neck. I reply calmly and with authority, “No.” 

 I am trained in laser surgery. It has almost zero usefulness in your spine surgery and in fact may be harmful.

The truth is minimally invasive spine surgery, or MISS, can be performed as effectively, and probably more effectively, without a laser.  In fact, more than 95% of minimally invasive spine procedures in the U.S. are done without laser.  MISS is based upon the surgical approach to the spine, not what kind of scalpel a surgeon uses.

Some might argue that the laser is an appropriate (or ideal) tool for spine surgery, but this is not generally accepted within the neurosurgical spine community or among leading spine surgeons.  The laser has been around spine surgery for more than twenty years.  With the exception of lipomeningocele surgery, it has not gained mainstream acceptance.  While any technology can be improved or in some way modified to work, at the present time I do not see that happening with laser spinal surgery.

If you are considering laser spinal surgery, ask yourself a few important questions. 

·        Does the practice or institute you are considering teach courses on the use of the laser at national spine meetings?

·        Are they disseminating this information to the medical community to better society? 

·        Is this procedure they are proposing something that other respected surgeons around the country and world have adopted? 

·        If the answer to these questions is ‘no,’ that should raise a red flag

If one person or group does laser surgery and markets it, it is a gimmick.  When a number of surgeons adopt the technique and long term studies demonstrate safety and significant benefit, then laser spine surgery may be a legitimate option.

One recent study published in 2016 found that not only were lasers significantly less effective than minimally invasive microdiscectomy, but that they also resulted in a near doubling of the need for a subsequent surgery. Certainly, these are not the kind of results that would lead me to change my thoughts on the use of lasers in spine surgery.

Although gaining popularity in the lay public, at this time many spine experts have not endorsed this technique.  Laser spine surgery may not be appropriate for most patients.  Before you choose to have laser surgery of the spine make sure you have more than one opinion from a fellowship trained orthopedic or neurosurgical spine surgeon.

Another spine surgeon, Peter F. Ullrich, Jr., suggests laser is mainly a marketing ploy in his article, Laser Disc Decompression for Spinal Stenosis: Does it Work?:

It seems to me that the most practical use for lasers in spine surgery is for marketing. Like most businesses, spine surgery is very competitive, and having an edge in marketing can make a practice standout. I knew a spine surgeon who would tell his patients he could use a laser to do their surgery. He would cut the skin with a scalpel, then bring in a laser to cut the subcutaneous fat, then go back to electrocautery. However, since the laser was so slow, he would only use it for about thirty seconds before he went back to electrocautery. The laser performed no useful function during the surgery, but helped him for marketing purposes.

Deceptive Results

Nor do these MISS ads disclose the potential adverse events such as the extraordinarily high re-operation rate of 38% in patients who required open disc surgery after MISS decompression surgery failed to relieve their symptoms.[2]

In 2009 a RCT study published by JAMA compared traditional open surgery versus MISS found more startling results that I doubt are ever mentioned on its Informed Consent form by Laser Spine Institute to potential MISS patients.

Subjects in the MISS discectomy group had:

·        slightly more intraoperative and postoperative complications.

·        slightly greater proportion of the minimally invasive surgery group had a recurrent disc herniation,

·        greater proportion had repeat surgery within a year,

·        patients who underwent MISS discectomy fared worse with regard to back and leg pain, and

·        fewer patients reported complete recovery at one year.[3]

According to an article, Lasers in Spine Surgery: A Review, by Jack Stern, MD, PhD, FACS:

Evidence-based data regarding application of laser technologies to the spine are limited. Challenging variables include patient selection, operative indications and the types of laser used… These shortcomings make analysis difficult. To date, laser discectomy may be more effective in attracting patients than in treating them.

Not BBB Accredited

Laser surgery ads certainly attract patients, but it also has its consequences when things go wrong.

Wrestler Hulk Hogan sued Laser Spine Institute for $50 million, alleging unnecessary and botched surgeries. According to TMZ Sports, “HULK HOGAN Sues Laser Spine Institute: You're a Bunch of FRAUDS!

Hogan claims the procedures actually made him feel worse in the long run and blames the institute for not advising him that the laser treatment is only a temporary solution, not a permanent one. Hogan claims he eventually had to undergo major back surgery with a different set of doctors and they actually fixed his back. 

An exposé by Bloomberg News that examined Laser Spine Institute LLC, which bills itself as “the largest spine center in the world” employing 800 people nationally, including 600 in Tampa, but had nearly seven times the number of medical malpractice lawsuits filed compared to outpatient surgery offices nationally.

Bloomberg News in a 2011 article noted 15 lawsuits had been filed against Laser Spine Institute since October 2009 and that it had paid at least $2.8 million to settle cases with seven patients since July of that year.

Many MISS patients have filed complaints with the Better Business Bureau’s “Reviews and Complaints.” Their complaints include shady financial issues and poor outcomes. Clearly posted now on the BBB website is this warning about the Laser Spine Institute, LLC: “THIS BUSINESS IS NOT BBB ACCREDITED.”

 

Apparently many patients complained of the “bait and switch” financial dealings with the LSI offices, “bird dog” telemarketing, and poor clinical outcomes.

 Here are a few highlights from disgruntled patients who posted complaints on the BBB website:

·        We were told our portion of surgery would be $2,400.00, which we paid. They are now sending us bills for $39,600.00

·        Everything about this process has been terrible. I am out $4400 and am still in back pain that they won't fix. They want me to pay $6000 for another 'attempt' to fix me, with no guarantee that it will actually work.

·        I have been diagnosed by a neurosurgeon with the VA of having OPLL in my cervical spine. As the surgeon with the VA has NO FINANCIAL INCENTIVE, I sought a second opinion with the Laser Spine Institute. The surgery planned by the VA is very extensive. My first encounter with the Institute was through their on-line chat. I was going to pay cash, as the VA is my only source for healthcare (I am 100% service-connected). I was quoted a cost of $18,900 without their even knowing about my condition. I sent my information, anyway, to what seems to be their corporate office in Florida. They followed up with a telephone call, and it was then I was quoted a price of over $22,000. When I said that I was initially quoted $18,900, I was told that I was quoted the Medicare price. When I balked at this, indicating that I should be charged less as I am paying cash, I was told that they bill Medicare anywhere from $60,000 to $70,000 dollars! What happened to the $18,900 price? As with anyone who practices fraud, you have to remember your lies. They also tried to talk me into surgery for my thoracic spine, which was not part of the "problem" that I was addressing. STAY AWAY FROM THESE PEOPLE! They focus more on their marketing than they do with focusing on the patient's NEEDS.

·        What a scam! Called for my "free MRI review" to see what they offered and if they can help my long term issue with my cervical spine. There are no direct numbers to their centers, instead you are given a "care specialist" in a call center. They take your info and insurance information and state they will call you back within 2 days. Roth called me back and told me they are out of network with my 2 insurance companies but they will work with me. I was told my procedure is normally 20K without insurance and since I am out of network they determined I will owe 10K??? What? First of all I was never seen by a doctor nor did they even look at an MRI so how can they know what procedure or procedures are needed to quote a price? Secondly, since my out of network coverage is 80% and my secondary covers they balance in full, how is this 10K? When questioned I was told the insurance company doesn't pay their full fee so I have to pick up the difference above the usual and customary fee??? 
What a scam. No doctor evaluation, just a sales company trying to sell you a full package not covered or needed... STAY AWAY!

·        When we made our initial agreement with Laser Spine Institute, we were advised our portion was $1000. We paid it off in July 2016. From the beginning, dealing with them was difficult and we wish we had not dealt with them, but when one is in great pain, every day, all day, as my husband was and still is, foolish mistakes can be made. My husband had a medical procedure on March 25, 2016. Though the surgery did not work, we put it behind us. I was very surprised to receive a bill from Laser Spine Institute in December 2016 for $9200.00.

·        How can an institute scam people out of money like this? The Laser Spine Institute is only for the rich.

·        OMG, where does one turn to?? After reading dozens of remarks written by so many of you (90% negative) I am amazed that these people have been allowed to get away with this. I think there is a local TV station here in SW Florida that does exposes on companies like this. I think it's called "Shame on You" I was already to go up there and thank God I skimmed further down to read these complaints!! Each one is so alike. I spoke to them early this year and was told that they accept Medicare but not my supplemental United Heath. I asked them that it seemed strange that Medicare would pay but not for the outpatient facility!! Then they had the nerve to tell me that I had to pay "out of pocket" almost $15,000 for the use of the facility. When I asked them how long would I be in their "facility" they said less then half a day!!! My next question was how can they justify $15,000 for basically an outpatient service. I was then given some sales pitch that the $15,000 also included all the doctors, MRIs and they would have be back every day for 5 days!!! When I said to them that they previously told me that Medicare paid for the "doctors" they said that there were "other doctors" that had to be compensated!!! Needless to say I hung up the phone and then they had the nerve to call me back several times to get me to change my mind!!! Thanks to all of you who took the time to expose this company. Are there ANY other Laser Institutes here in this country that offer the same procedure without ripping one off??? If so please let me know. Sincerely, Rick M

·        I needed back surgery. We were told the maximum amount they would charge us. Now we receive an astronomical bill. Tried resolving with company. I have been in horrible pain for year

·        This company is a complete scam. They reeled me in by telling me it'd only be $1000 total out of pocket with the insurance I have. Then, after paying the $1000, I receive another bill for almost $8000. Then I wake up one day and I'm now in more pain than I've ever been on a consistent basis. This company shouldn't be in business

·        Laser Spine Institute does not accept Medicare and that they aren't Medicare accredited and I would have to pay 13,900.00$. I was devastated! I can't afford that… I feel that I was involved in a Bait and Switch scam. I thought I'd come back home with relief from my pain, had my hopes shattered! For Shame Laser Spine Institute, for Shame!

·        They then told me the only option I have now is to take pain killing drugs and injections, which was what I was seeking to avoid by having the procedure. I was looking for permanent relief… I would stress that anyone considering Laser Spine Institute avoid it like the plague.

·        I had a herniated disk between L4 and L5. They insisted that I needed surgery and it was going to be very expensive. Went for a second opinion to a spinal doctor at a very reputable hospital and was told I absolutely did not need, or should I have the surgery. The reputable establishment told me that Laser Spine Institute is essentially just a money making scheme

·        About 10 years ago after trying many passive treatments for severe lower back pain I contacted LSI. It is a production line. Every Appt. was 1-2 hours late except when it came time to pay $30,000 TO ALL WHO READ THIS-DO NOT EVER, EVER GO THERE. THEY ARE MONEY GRABBING QUACKS.

·        I had fusion back surgery in January 2016, 2 months later I was still in a lot of pain and called them. They assured me that my surgery takes 1 year to realize the benefits. Well, I am now 1 year later and I am not only still in lots of pain but I am without a doubt worse than I was before surgery. I am currently taking more pain medication than I did before surgery. They want me to go to physical therapy but I'm in too much pain to do that.

·        After taking my $250 non-refundable deposit, they gave me the so- called free MRI review (never asked for the MRI images, just looked at the radiologists written report) and said I was an excellent candidate. Then the run-around and stalling began. They always needed more documentation. Just one more record. Clarify this. More doctors comments. The whole process came to a screeching halt when they discovered that I was taking a baby aspirin… If LSI can not deal with a baby aspirin, what would the do if something actually serious came up.

·        I contacted Laser Spine Institute in April of 2012 in desperation after suffering upper back along with severe arm and hand pain for over a decade despite years of conservative treatments (I had suffered fractures to thoracic vertebraes 3, 4, and 5 in 1999). I sent them MRIs of my cervical and thoracic spine and was told that I needed a cervical surgery first (That seemed odd to me bc my cervical MRI report stated that my C-spine was normal). The exact words the doctor used were "you have a torn spinal disc". As I later learned, that condition does not exist!! I was told I would likely need multiple surgeries. I did get some relief initially, but several months after undergoing surgery on my neck (right C6 level), I developed severe facial pain, now along with the back, hand, and arm pain. But they had told me I would need multiple surgeries so ignorant me I had a second surgery (right C7 level) in May 2013. Well that made the face pain worse. Talking became unbearable and bc my job required lots of talking (I was a college professor), I was in intractable pain. The head and face pain led to panic which just made everything worse. I had no choice but to leave my job by May 2014 and have since had to apply for disability. I went back to LSI in June 2016 after 2 years of continuous physical therapy and multiple specialists who said they didn't know what was wrong, thinking I must need surgeries on the left to even things out. Over the phone, they told me again that I was a cervical surgery candidate for the left side and I scheduled the surgery, and traveled the 8+ hours there. There they did another MRI, took blood, etc., cleared me for surgery and then 2 days before I was supposed to have the surgery, the doctor I met with said he didn't think the pain from coming from my C-spine. Note that they charged my insurance for all this stuff so they made me travel all that way in pain, waste money on hotels and gas, and ran up a few Ks on my insurance. Despite this, I am grateful that at least this doctor didn't order surgery and instead said he thought I had thoracic outlet syndrome (TOS) and that I should see someone who specializes in upper extremity nerve compression syndrome. It turns out he was right about that condition. I had TOS, along with severe fascia restrictions, and what LSI did just made that condition worse. I have undergone surgeries (the correct ones!) to release my brachial plexus nerves (the pain was never coming from my C-spine!!) and lots of myofascial release sessions with a massage therapist in the past year and my pain is much improved except for the face and head pain which is mostly on the right (where the LSI surgeries were performed). Beware of this company! They might perform unnecessary surgeries. Definitely get another opinion before you have a surgery at LSI! I was so desperate for pain relief that hearing someone say "we can take your pain away" (was first told this by a customer service rep) felt like a miracle cure. I had had laser surgery to correct my vision years earlier and I thought it would be the same - just like the LSI commercial shows - you walk away "fixed". Not so - there is definitely post-surgery recovery involved!! I now have debilitating PTSD, in large part from dealing with the intractable head and face pain from XXXX - XXXX, am still in physical pain, and my career is in all likelihood over - even if I could work today, I'd likely never be able to attain a tenure-track professor job after being out of work for 3 years. Recent EMG studies show C7 nerve damage on the right. Pre-surgery EMG showed normal function. My C-spine MRI now shows pathology. Thanks a lot LSI!

·        On June 27th, 2016 I had decompression and what my doctor calls "shaving" of the disk. Unfortunately, I am currently worse; my muscles around the surgery, being weak allowed to other muscles to hurt my back in a way that I now suffer worse pains and suffer of it on my neck as well. Everything before and during the two days follow up sounds like an Alice in Wonderland story until you say that you are still in pain. Shame on all of you! 

·        What a scam. It all sounds so good on the commercial. Do yourself a favor and check with your local spine doctor and insurance first. Sure they will tell you that you are a perfect candidate and that their services are covered by insurance. If your condition is not too severe, their procedures may even work. If that is the case, your local, in network spine doctor can perform a similar procedure.

·        If it sounds too good to be true, it generally is. Don't be fooled by the fast talking sales reps. The Laser Spine Institute is set up to make money. They have to pay for all the commercials and fancy advertising.

·        Shame on you. Back pain sufferers beware. The initial MRI that was sent in for review should have been sufficient to show that I was not a candidate. I am sure everyone who applies is told that they are a "good" candidate. Laser Spine is a scam. Consult your local spine doctor before wasting an entire day and having additional, unnecessary tests performed at Laser Spine.

·        We were told our portion of surgery would be $2,400.00, which we paid. They are now sending us bills for $39,600.00. 
My husband & I saw an ad for Laser Spine Institute, & I was deemed an appropriate candidate. I talked to a care specialist, who assured me several times that we would pay nothing ...

·        In June, 2017 I was interested in getting laser spine surgery. The commercial said there was a free MRI and consultation. When I spoke to the finance dept about the cost the only amount they gave me was $1,250. I arranged to make payments of $50 a month for 20 months. I just received a bill on 12/06 that I owe $10,977.62. When I call them they stated that if you would have read your contract it stated that it was a down payment pending insurance.

·        I am glad I checked with my insurance before going ahead and scheduling 5 different surgeries out of State with a Dr that I have never met or talked with. My complaint to the BBB is that the Laser Spine Institute is a racket and my hopes are that other people do not fall for their gross sales pitch. I am in great pain and would do anything to resolve it at this point, which is why I contacted them in the first place. Minimally invasive surgery and back to work in a couple of days is their pitch which is too good to be true.

·        Had their so called surgery. No relief. I was also taken by this scam. Had to pay 30k up front. Was assured by LSI that my ins (bcbs) would pay the entire amount since I had met my copay for the year. After fighting with bcbs for over two years received only about 6k. LSI basically said tough luck. The so-called operation was a complete failure. I am in worse pain than before their "surgery". This scam needs to be stop. Taking advantage of people desperate for help is just wrong. Please help me get some of my retirement money back. Would love to talk to someone about this. Contact me anytime as this is only a small part of my LSI nightmare.

·        I have been suffering with back pain for several years. I've also had 4 spine surgeries within the last 8 years. I was home watching TV and saw a advertisement for Laser Spine Institute. Based on what I saw, I figured I will call them to see if they could help me. The representative on the other end asked me a series of questions and then ask me if I agree to have my medical records release from my prior surgeries. Of course I agreed, and after they received my medial records from my Dr. in NYC, the representative called me minutes later (and I still have the VM) telling me that they received my MRI'S and I was indeed a candidate, and they would be able the help me. I was overly excited and could not wait to be pain free! Now here comes the tricky part...

·        Laser Spine Institute's high pressure sales staff misrepresented what the company could do and caused me to spend a lot money in travel and lost work. Laser Spine Institute advertises that it can perform minimally invasive spine surgery which is a very attractive alternative to spinal fusion. It appears to me they get their business through sales or marketing staff or "bird dogs" that drive business to the company To me it appears they are drumming up business using a telemarketer who represents himself as a staff member with a fair amount of medical knowledge. They may be withholding response because it appears that I might have a legal position and they do not want to incriminate themselves. 

Salt in our Wound

Obviously the marketing of pain is a huge business despite the debunked diagnosis and poor outcomes. The Lancet review also mentioned the need to police the perverse motivations:

Increased use of ineffective potentially unsafe treatments has wasted limited health-care resources and harmed patients…

Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo…

Implementation research is necessary in all countries to ascertain how best to use existing knowledge and evidence through changes in patient and clinician behaviour and health system design.

Whether OTC drugs, prescription painkillers, epidural steroid injections, pillows, copper braces, electrical devices or, most of all, laser spine surgery, the rewards grow bigger daily by conning the public with useless remedies because no federal agency polices them unlike the FDA that regulates prescription drugs.

Paradoxically, despite the horrible reviews and the loss of BBB accreditation, the Laser Spine Institute is now a sponsor of the American Chiropractic Association. I am stunned that the ACA is willing to throw its own profession under the medical bus if it can make some easy money while sleeping with the enemy.

This quid pro quo reminds me of 1930 when Morris Fishbein, the Medical Mussolini, jumped in bed with Big Tobacco to make millions to fuel his political war against chiropractors.

If the AMA today were still in bed with Big Tobacco as it was from 1930 to 1986, the press and public would cry medical hypocrisy.

Now in the era of opioid deaths, Big Pharma has finally begun to decrease its advertising payoffs to MDs. According to an article in ProPublica, Opioid Makers, Blamed for Overdose Epidemic, Cut Back on Marketing Payments to Doctors:

The past two years have been a time of reckoning for pharmaceutical manufacturers over their role in promoting opioid drugs that have fed a national epidemic.

In 2016, drug makers spent $15.8 million to pay doctors for speaking, consulting, meals and travel related to opioid drugs. That was down 33 percent from $23.7 million in 2015 and is 21 percent less than the $19.9 million in spent in 2014.

So why hasn’t the ACA and F4CP taken the same tactic to make spine surgeons squirm about their unnecessary surgeries? The proof is there, but we need to prosecute in the court of public opinion.

If the chiropractic profession had suffered similar setbacks as the Laser Spine Institute — loss of BBB accreditation, ineffective treatments based on debunked premise, numerous patient complaints, financial irregularities, huge costs, and multiple lawsuits, our profession would have been skewered in the court of public opinion by the media and impugned by the medical curmudgeons to discredit our image as an “unscientific cult.”

On the other hand, imagine how it would have improved our image, increased our market share and improve the lives of millions of people if the F4CP or the ACA had publicly confronted the ‘bad disc’ as a “widespread misconception” for LBP as well as informing the public of the high rates of failed back surgery and the guidelines calling for chiropractic first.

Instead of being the proverbial outcast in the spine industry suffering with the “quackery” stigma branded by the chirophobes within the AMA, we chiropractors would be seen as rescuers from opioids, ESI and surgery if we had a progressive PR campaign touting the new guidelines and the travesty of medical spine care.

I propose our profession begin using disruptive journalism that would excite the public; instead the ACA and F4CP are locked into outdated concepts. Take a look at this menu of audio clips and see if there’s one that catches your eye:

Simply put, we will not gain any press attention talking about back packs and posture as our calling cards; we should be exposing the ‘bad disc’ fallacy, the high rates of unnecessary spine surgeries including laser MISS and, of course, the scourge of opioid painkillers brought to Americans by “Dr. Chapo” who created this Pharmageddon of addiction and deaths.

In this era of evidence-based care, the facts are clear our brand of nondrug, noninvasive care is best suited for most LBP cases, but we have not used this evidence to our advantage. We need to create controversy by attacking the medical spine care mess that is rampant in this country. We need a voice in the earned media to tout ourselves rather than paid ads in newspapers.

The evidence is clear to support such criticism unlike ever before with controversial topics that will flip the public’s impression of our profession as the Ralph Nader of medical care—a chiropractic whistleblower who they need to hear.

Why we avoid confronting this issue remains a mystery, but it does beg the question: Does our chiro leadership have the backbone to tell the public of this leading back surgery scam?



[1] David Armstrong, Laser Spine Surgery’s Profits Beat Google’s Amid Complaints, May 4, 2011; Bloomberg News.

[2] Brouwer PA et al. Percutaneous laster disc decompression (PLDD) versus conventional microdiscectomy in sciatica: A randomized controlled trial, The Spine Journal, 2015.

[3] Arts MP et al., Tubular discectomy vs. conventional microdiscectomy for sciatica: A randomized controlled trial, JAMA, 2009; 302:149–58. BackLetter: September 2009 - Volume 24 - Issue 9 - pp 97,104,107



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