With any low back pain patient, we undergo a detailed injury history. Sometimes the history of a patient is quick, lasting 10 minutes. Other times, the injury history takes 30 minutes, especially in complicated low back pain cases. I’ll never forget one patient, she had undergone 5 spinal fusions (where they fuse two segments of the spine together) from 5 spine surgeons! With all these surgeries and hardware she was still having low back pain! In my Santa Clara office, I remember feeling exhausted after talking with her, as I put myself in her shoes. How does someone undergo 5 surgeries and still have pain? Perhaps it was due to the surgeon they had…
Low Back Pain Spine Surgery Differs Greatly Between Surgeons
A recent study (Lubelski 2015) surveyed spine surgeons. In survey, the researchers provided 2 case scenarios and found ~75% disagreement in the approach used! These approaches varied from spine surgery to no surgery…quite a big difference. Many will read this and jump to conclusions regarding unnecessary surgery for low back pain patients, but this isn’t necessarily the case. Other factors influencing this discrepancy were:
- Region: The southwest had the highest surgery rate, higher than the Bay Area or San Jose / Santa Clara. Disagreement is highest in the southwest and lowest in the midwest (82% vs. 69%, respectively).
- Type of Practice: There was a higher surgical rate in private practice compared to academia, significantly lower disagreement among those in academic practices versus those in private/hybrid practices (56% vs. 79%).
- Education: Those with fellowship training had ∼2 times greater odds of selecting no surgery and 4 times greater odds of selecting anterior lumbar interbody fusion (type of surgery).
5 Things to Do When Picking a Spine Surgeon
If you have low back pain, picking a spine surgeon is an extremely difficult process. Like picking a restaurant or a new car, doing research is crucial for finding the best spinal surgeon for you! Here are 5 things to consider when picking a spinal surgeon, whether you are in Santa Clara, Austin, or Phoenix.
1. Online Reviews: Nowadays, there are online reviews for everything (by the way, like us on Yelp) which can give you an idea of who may be a good fit. HealthGrades is another review website for physicians and medical personnel.
2. Conservative Treatment First: Unless you are in horrendous pain (and even then, spine surgery isn’t the first recommendation for low back pain), physical therapy and/or other conservative treatment is the first place to look. Another conservative approach is recommending a second opinion.
3. Are they in Academia or Private Practice: What is their spinal surgery specialty? Have they done research in this area? Are they a private practice facility or a academic practice? The aforementioned study suggests practice specialty influences surgical rates.
4. Frequency of Surgery: Knowing how many or often they perform this surgery is helpful. However, this doesn’t provide you all the information, as someone could simply be performing tons of surgery for money.
5. Personal Referrals: Can they provide you with personal referrals to discuss their recovery or procedure? Do you know someone who had a good experience with a spinal surgeon? These questions can help you pick the best spinal surgeon for you for a quick recovery. Just remember, not every case is the same. If someone recovered well, there are many factors which could have resulted in these outcomes. Don’t mix-up correlation with causation!
Conclusion
Thinking back on my patient with 5 spinal fusions, I think about what I would have told them before the surgeries. These 5 tips are what I would have told this patient to help her find the best spine surgeon for her. Use these 5 tips and find the best spine surgery for YOU.
Reference:
- Lubelski D1, Williams SK, O’Rourke C, Obuchowski NA, Wang JC, Steinmetz MP, Melillo AJ, Benzel EC, Modic MT, Quencer R, Mroz TE. Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States. Spine (Phila Pa 1976). 2015 Dec 14. [Epub ahead of print].