Surgery for Low Back Pain? It Depends Who You Ask

There’s no doubt that surgery can benefit patients with low back pain due to a degenerative lumbar spine.  However, the optimal selection of patients for surgery isn’t always clear, as a study reported in the journal Spine shows.

Canadian researchers presented hypothetical patient scenarios to surgeons (orthopedic surgeons and neurosurgeons), family doctors, and patients with back pain.  Each scenario contained information on key clinical factors: walking ability, pain location, duration and severity, neurological symptoms (pins-and-needles, numbness), and factors causing or worsening the pain.  Each group rated their preference for surgical treatment, giving their reasons. 

The surgeons had the lowest overall preference for surgery, and the family doctors the highest.  And among the surgeons, the orthopedic surgeon rated surgery lower than the neurosurgeons.  Both the family doctors and the patients preferred surgical treatment more than the surgeons.

The surgeons considered the location of pain the most important factor in their recommendation; in particular, pain in the leg was a greater factor than back pain.  For the family doctors, the most important factors were neurological symptoms, walking ability, and pain severity.  The patients in the study selected pain severity, pain duration, and walking ability.

The surgeons’ preference was probably guided by their experience.  Surgery gives better results in patients with problems affecting their spinal nerve roots, which cause leg pain. The factors that influenced the family doctors and patients were “quality of life” considerations, but they didn’t take account of the relative likelihood of a successful outcome.

The best solution to this discrepancy of viewpoints would be for all parties to recognize “where the other person is coming from”.  A conference between surgeon, family doctor, and patient should provide a better-informed decision by the patient.