Surgeons are less likely than family physicians to recommend lumbar spine surgery

[Justin]

February 2010, 1st on the web (February 1, 2010). Copyright ® 2010 SLACK Incorporated. All rights reserved.

Surgeons are less likely than family physicians to recommend surgery as the preferred treatment option for patients with lumbar spine problems; and patients, surgeons and family physicians have different factors affecting their decision-making regarding surgery, according to the results of a study appearing in Spine.

S. Samuel Bederman, MD, PhD, FRCSC, and colleagues hope that their research will help better align the opinions of doctors and patients and improve the shared decision-making process.

“This can directly result in a significant improvement in patient satisfaction with the health care process and even overall health status following treatment,” Bederman stated in a press release.

The investigators surveyed orthopedic surgeons, neurosurgeons and family physicians, to determine the factors influencing their recommendations for lumbar spinal surgery. They also surveyed patients regarding their preferences for surgery and the factors influencing their decisions.

The investigators presented the participants with hypothetical scenarios involving the following key factors:

• walking ability;
• duration of pain;
• severity of pain;
• location of pain;
• neurological symptoms; and
• factors inducing pain.

The groups ranked their recommendations and preferences for surgery regarding each scenario, and the investigators noted the factors impacting the participants’ choices.

Among the three groups, the investigators discovered that family physicians would recommend surgery most often, while orthopedic and neurosurgeons would recommend surgical treatment the least. The study also revealed that the most important factor regarding decision-making for surgeons was the location of pain, and that most preferred surgery for patients with leg pain compared to back pain.

For family physicians, neurologic symptoms were the most important factor regarding their recommendations for surgery followed by patients’ walking ability and severity of pain, according to the study.

In addition, the investigators found that pain severity, walking ability and pain duration were the most important factors regarding patients’ preferences.

“All of these symptoms are highly related to quality of life and have little direct bearing on outcomes following surgery,” Bederman stated in the release.

Orthopedics Today Editorial Board Section Editor Scott D. Boden, MD, said that the results of the study match his experience with the different groups that were surveyed.

“Family practitioners do not have the detailed experience to sort out which patients actually need surgery, but can identify patients that may benefit from surgery,” Boden told OrthoSuperSite.com. “Thus, many patients referred to surgeons either do not need surgery or decide not to choose surgery once they learn more details and are seen by more of a specialist.” He noted that many different lumbar spine problems often present with a similar or overlapping set of symptoms. However, only a specific set of lumbar problems best treated with surgery.

He added, “It is my hope that well-educated surgeons and patients that go through a true shared-decision making process will together make the most appropriate decisions about surgery on a case-by-case basis.”

Reference:
Bederman SS, Mahomed NN, Kreder HJ, et al. In the eye of the beholder: preferences of patients, family physicians, and surgeons for lumbar spinal surgery. Spine. 2010.1;35(1):108-115.

[Moni]

Justin,
Thanks for posting this.
It is a good read and very timely for me.
I go for my second CT scan tomorrow and then two days after I have a dr appt.
I need to get all informed up as he and I are going to decide what my next step will be. It's interesting because after my first CT scan in September my dr and the radiologist thought I should be fused at L5/S1 and sent me off to the neuro. He,on the other hand looked over the scan and said "nope". He did not question me about my range of motion,nor my pain levels,nor how how my life is affected by the pain.....just no. My back is messed up on quite a few levels but the worst is L5/S1.He went on to explain that the disc is completely gone except for a very small smear....he also explained that I have quite a severe narrowing of the foramin..( thank you Katie)...plus my spine is pushed to the right. Add a bit of arthritis and some pretty prominent bone spurs .. that is the cause of my problem.However, according to him...fusion is not the answer and the artificial dics aren't long lasting enough to do that surgery as I am only 53 and so it would be best that I wait until I am older??? Go figure?? What kind of thought process is that?
This article clarifies things a bit.
This particular neurosurgeon said carry on with your life...just don't do any heavy lifting(over 20 lbs) don't lift and turn,don't stretch and lift,don't sit too long,don't stand too long,loose some weight ( that the 3 years of medicating my my "mysterious leg pains" with antidepressants packed on) and more recently the gaba,strengthen your core...but don't come to me for surgery! HELLOOO!!!! I did not ask for surgery I came with a CT scan that says I have a messed up back...I hurt badly and would like to know what can be done for me. I was told what wouldn't be done for me....by him anyhow.
I am wondering, Justin about the damage to the nerves?? You mentioned that in one of your posts....
I am medicated with gabapentin to keep the nerve pain to a level where I can function,then I have straight codeine for the pain ( it dulls it but does not take it away) also I have Valium and T3's when it gets real bad...which it does. If I was to take no meds the pain would have me almost stopped.
My question is, and I am not getting an answer from the drs; am I doing permanent damage to my nerves when I take the pain blockers/deadeners? and carry on.
I'd appreciate your input and the thoughts and opinions and/or experiences of any others on the site that might be able to give me some insight.
This is I think my biggest concern right now. Am I doing more damage that will be of a permanent nature?
I liken it to putting my hand on a burner but not being able to feel it burning because I have blocked the pain messages from reaching my brain!?
Does this make any sense?
mg

[Moni]

I deleted my question.