A study published in the January 1, 2010, issue of Spine revealed that spine surgeons, family doctors, and patients have different views when it comes to choosing surgery as a preferred low back pain treatment. Researchers found that spine surgeons were actually less likely to recommend spine surgery, compared to patients and family doctors.

The research team, which was led by Dr. S. Samuel Bederman of the University of Toronto, received survey responses from 131 orthopaedic and neurosurgeons, 202 family doctors, and 164 patients with back pain. All the participants were located in Ontario, Canada.

The researchers gave the participants hypothetical back pain situations. These scenarios featured many common back pain factors:

• Impact on walking ability
• Intensity of pain
• Pain duration
• Neurological symptoms (such as numbness and tingling)
• Primary pain location

As a group, the spine surgeons were least likely to recommend surgery as the best treatment option. The orthopaedic surgeons surveyed were less inclined to suggest surgery than the neurosurgeons. Family doctors and patients, however, had greater preferences for surgery.

What Factors Make Surgery the Best Option?
The research team also evaluated the factors that each group found most important to their decision to recommend surgery. Spine surgeons reported that location of pain was the dominant factor in whether to perform surgery. The researchers wrote that this is likely because patients with leg pain—not back pain—are more likely to experience better results from surgery.

On the other hand, family doctors chose the presence of neurological symptoms as the most important factor in choosing surgery. The research team noted that family doctors may not fully understand what factors most impact surgical outcomes.

The patient respondents put the most importance on quality of life factors—reporting that pain severity, walking ability, and pain duration made surgery the optimal treatment option. According to Dr. Bederman, these factors "…have little direct bearing on outcomes following surgery."

Aligning Treatment Preferences
The research team concluded that spine surgeons, family doctors, and patients all have different viewpoints about whether surgery is the best treatment option for back pain. But the researchers are hopeful that this study will help "align" the differing opinions.

Since the decision to pursue surgery is one that is often shared among patient, family doctor, and spine surgeon, it's especially important that spine surgeons and family doctors have similar expectations and opinions when it comes to suggesting surgery. That way, family doctors will refer only the best surgical candidates to spine surgeons.

As for patients, the researchers believe spine surgeons and family doctors can benefit from the knowledge of what drives patients' treatment preferences. Quality of life factors may make patients believe that surgery is the best option, but surgeons understand that those factors may not be reason enough to have surgery. The researchers hope that findings help surgeons and family doctors foster accurate surgical outcome expectations for their patients.

To learn more about this study, you can access the abstract here.