Spine surgeons are surprisingly less likely to recommend surgery for lower back pain than family physicians and patients, according to a recent study in Spine.
The study added that spine surgeons will typically recommend back surgery for leg pain before back pain based on the causes of pain and effectiveness of surgeries.
To understand the preferences for surgery among these different groups, researchers presented hypothetical scenarios to approximately 131 spine surgeons (orthopedic surgeons or neurosurgeons), 202 family physicians and 164 lower back pain patients.
These scenarios incorporated 6 clinical factors, including walking tolerance with the pain, duration of the pain, neurologic symptoms, pain severity, typical onset of pain, and the dominant location of the pain.
According to the study’s findings, family physicians had the highest overall preferences for surgery and viewed neurological symptoms, walking ability and pain severity as the most important factors for deciding to have back surgery.
Patients had the next highest overall preference for back surgery and viewed pain severity, walking ability and pain duration as the most important clinical factors.
Unexpectedly, the spine surgeons had the lowest overall preferences for surgery, with neurosurgeons preferring back surgery slightly more than orthopedic surgeons. The spine surgeons viewed location of pain as the most important clinical factor for spine surgery.
The study explained why spine surgeons would view leg pain instead of back pain as a better indication for back surgery.
Leg pain often results from problems with the spinal nerve roots that can be effectively treated with surgery. However, the causes of back pain are often more complicated and less effectively treated with surgery.
Considering this important difference, spine surgeons are more likely to suggest that patients with back pain continue to try different non-surgical treatments. If such care proves ineffective over time at alleviating the pain, back surgery may then be more seriously considered.