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Surgical management of low back pain

Leigh Atkinson and Andrew Zacest
Med J Aust 2016; 204 (8): 299-300. || doi: 10.5694/mja16.00038

Spinal surgery for chronic low back pain is controversial, and the disproportionate number of fusions in private hospitals is unexplained

In developed countries, low back pain is the most common presenting symptom in primary care practice, with a lifetime prevalence of 80% for episodes of back pain.1 It affects adolescent sportsmen, pregnant women, hospital nurses and middle-aged labourers, and it peaks in the elderly.1 Back pain disrupts the rhythm of daily life, affecting work, recreation, social life and family income. The level of disability has a significant cost to the community.

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  • Leigh Atkinson1
  • Andrew Zacest2

  • 1 Wesley Pain and Spine Centre, Brisbane, QLD
  • 2 Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, SA


Competing interests:

No relevant disclosures.

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access_time 03:17, 5 May 2016
Michael Thomas Biggs

Surgical Management of Low Back Pain
Atkinson and Zacest article in the Med J Aust warns that the outstanding results from hip and knee arthroplasty has led patients to expect similar results for spinal surgery, particularly spinal fusion, in terms of relieving low back pain.1 They discuss the Cochrane review in 19992, concluding that there were no published randomised controlled trials which established effectiveness of fusions for chronic pain. In 2005, an updated review was critical of the outcomes measured, preferring “patient-centred outcomes rather than an assessment of the short-term surgical outcomes”3. This emphasised that reports needed to focus on the patient’s perception of pain relief and the patient’s return to the previous level of daily activities and employment. Atkinson and Zacest suggest that the indications for spinal fusion remain controversial and that further research is needed, perhaps through a national audit of spinal fusion outcomes, the same as has occurred with hip and knee arthroplasties.
The International Consortium for Health Outcomes Measurement is a not for profit organisation founded by The Institute for Strategy and Competitiveness (Harvard), the Boston Consulting Group, and the Karolinska Institutet in Sweden. Their mission is to unlock the potential of value-based health care by defining global sets of outcome measures that matter to patients for the most relevant medical conditions and by driving adoption and reporting of these measures worldwide. Through development of datasets they are trying to address problems such as: a) paucity of outcomes data beyond basic mortality measures b) inability to compare outcomes that are available because of non-standardisation c) non- patient focused outcomes.
Atkinson and Zacest’s plea for further research and national audits comes at an opportune time. Ramsay Health Care announced a strategic alliance with ICHOM on 5th August, 20155. Two Ramsay hospitals, North Shore Private Hospital in Sydney, and Pindara Private Hospital on the Gold Coast have just passed ethics approval to start collecting Patient Reported Outcome Measurements (PROM’s) in the treatment of Low Back Pain, whether it be conservative, interventional or surgical.
Over the next two years we hope to be able to contribute patient centred data to add to the literature on low back pain management.

Michael Biggs
Neurosurgeon, Director of Medical Services, North Shore Private Hospital
1. Atkinson L, Zacest A: Surgical management of low back pain. Med J Aust 2016; 204(8): 299-300.
2. Gibson JN, Grant IC, Waddell G. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine (Phila Pa 1976) 1999; 24: 1820-1832.
3. Gibson AJN, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane review. Spine (Phila Pa 1976) 2005; 30: 2312-2320.
4. PH News. http://phnews.org.au/ramsay-health-care-announces-strategic-alliance-with-ichom/)

Competing Interests: I am employed part time at North Shore Private Hospital as Director of Medical Services

Dr Michael Thomas Biggs
North Shore Private Hospital

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