Re: Now On PTManagerBlog: Spinal Fusion Surgery May Leave Some Back Pain Patients Worse Off: Study

February 26, 2011

,

Thank you for the post - surgeons are starting to see that all lower back pain

is not the same.

Their outcomes are poor because they're lumping every patient into the surgical

treatment group based on imaging findings.

Once surgeons start identifying homogeneous sub-groups of surgical responders

vs. non-responders they'll start to behave in two different ways...

....they'll order less diagnostic imaging if its importance in predicting outcome

is less helpful than findings from the history and physical examination.

....and...

....they'll perform less surgery as the prevalence of the surgical responder

group is found to be much lower than imaging findings suggest.

Anecdotal evidence implies less than 1% of chronic LBP patients need complex

spinal fusions costing $88,000.

The challenge will be to persuade surgeons to use decision rules that predict

who is in the surgical group rather than imaging.

Medical culture resists " top down " decision rules while imaging is often

demanded by patients.

The science behind decision rules, similar to Treatment Based Classification, is

sound but persuading physicians will be no easier than persuading physical

therapists who prefer to practice using unaided decision making because that is

their " art " .

Tim , PT

>

> NOW on PTManagerBlog.com

>

> Spinal Fusion Surgery May Leave Some Back Pain Patients Worse Off: Study

>

> Kovacek, PT, DPT, MSA

>

> PKovacek@...

> Cell (313) 492-4293

> Personal Fax

>

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