Bangor is rated first in the nation in minimizing a somewhat controversial surgical procedure called lumbar fusion. Nationally, surgeons perform the operation five times as often as Bangor. In Idaho Falls, Idaho, tops in the country, they do it 20 times as often.

The data, 2000-to-2003 figures from the Dartmouth Atlas of Health Care, suggest that Bangor surgeons are more conservative than most in performing a sometimes-questionable operation.

Probably half of American adults suffer from back pain at one time or another. “Oh, my aching back” is more than just a figurative complaint. And lower back pain seems to be the worst. For treatment, they often want lumbar fusion, a method of immobilizing the connection of two vertebrae where deterioration has occurred.

There are drawbacks. Fusion takes three to six months, sometimes as long as 18 months. It is inappropriate for some patients. It doesn’t always work. And it costs around $50,000.

The Mayo Clinic, which conducts an annual International Spine Surgery Symposium, includes “Minimal Invasive Surgery” and “Non-Operative Treatment of Back and Limb Pain” among this year’s program highlights. Another topic is “Lumbar fusion for back pain: patient selection and decision making.”

Spine-health.com, an online source for back pain, says it is up to the patient to decide whether to undergo fusion. It recommends getting “a second (or third) opinion from other surgeons and/or other types of spine specialists” before deciding for or against spinal fusion. Some surgeons oppose fusion surgery entirely, while others are very willing to offer it. The site concludes that it is usually effective when done by a skilled surgeon for a patient with the right indications.

Bangor’s record-low use of lumbar fusion appeared last week in a New York Times column that cited lumbar fusion as “about as good an example as you can find of the health care mess.” The writer, David Leonhardt, noted that the procedure seems to help people with certain kinds of pain, although others recover just as well without surgery. Mr. Leonhardt wrote that Medicare now spends $600 million a year on this procedure. He mentioned also knee replacement and preventive angioplasty as expensive and medically questionable care that makes health insurance so costly.

So Bangor can take credit for conservative surgery that points the way toward improvement of the health care system. Avoiding costly unnecessary and inappropriate treatments can stem the system’s mounting cost and help make health insurance more affordable.