The ABC 7.30’s recent report on back pain identified the poor results produced by lumbar fusion surgery. The 7-minute story is a must watch for anyone with severe and chronic back pain who is contemplating surgery.
The report stated that in 2017-18, close to 18,000 fusions were carried out in Australia. It’s one of the most common forms of surgery for chronic back pain. But there’s a growing debate about whether surgery is the best way to treat most back problems.
Professor Ian Harris, Orthopaedic Surgeon said. “It’s a low level of evidence that we accept and I don’t think that’s good enough, particularly for highly invasive, risky and costly procedures like spine fusion.”
Professor Harris admitted that he no longer operates on backs. He said, “I realised that the evidence wasn’t very supportive and it wasn’t very strong. And in fact, for many of the procedures that I was performing at the time, there was evidence that they probably didn’t work.”
Nevertheless, there may be a certain subset of patients with back pain where surgery can be beneficial. The trouble lies with a system that incentives procedures. Surgeons are paid to do surgery and the current health system rewards them for doing so, irrespective of the outcomes.
In contrast there’s very little support from that same system, say for non-operative management of people with chronic back pain.
Professor Harris reported that, “There is evidence that structured physical therapy programs or even cognitive behavioural therapy is as good as spine fusion for people with chronic low back pain.”
Starting with physiotherapy is a wise, cost-effective and safe way to treat back pain. And with strong connections to surgeons, physiotherapists are well placed to ensure the small subset of back pain sufferers get appropriate referral to surgery.