Are Patients and Clinicians Following The Evidence Before Back Surgery
We have written previously on the limitations of back surgery to reduce pain, disability, and improve function in patients with back pain. The mismanagement of low back pain, including unnecessary surgery, can often be traced back to a clinician practicing outside of evidence based clinical guidelines. This unwarranted practice variation leads to higher health care costs due to unnecessary imaging, medication use (opiates), and medical procedures.
A recent article in The Spine Journal examined which activities and treatments are performed by patients and clinicians before consultation with a spinal surgeon and if these activities and treatments are consistent with the most up to date practice guidelines (Layne et al. 2017). Authors studied 229 patients who were referred for an initial surgical consult for their spinal condition. Not surprising, 74% of patients received medication with close to half of these patients receiving opiates for their low back pain. Interestingly, patients who had the highest pain, disability, and lowest function utilized the greatest amount of medications while the patients with the lowest pain and disability performed the recommended amounts of exercise.
The authors concluded many evidence based treatments for low back pain, including Physical Therapy, were not taken advantage of prior to a spinal surgery consultation. Early, evidence based treatments for low back pain may prevent the need for surgical intervention and limit the amount of patient deterioration occurring while waiting for a surgical consultation.