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Conservative Treatment as a Valid Option for The Vast Majority of Patients with Back Pain The accurate diagnosis of lower back pain origin remains a difficult and often very elusive task. Patient complaints, findings upon physical examination and, especially, results of imaging studies frequently contradict each other and their interpretation largely depends on physician's expertise and motivation. All this can immensely influence the treatment plan options. A typical approach of a primary car provider, while dealing with lower back pain patients (especially ones having radicular symptoms), is to immediately refer them to an orthopedist or neurosurgeon for a consultation. Naturally, it is up to one of these specialists to make this crucial decision regarding the patient's treatment (conservative vs. surgical). It is no wonder that the surgical intervention is so often chosen over the conservative one. About 317,000 lower back surgeries alone are performed in the U.S. every year. The cost of each intervention is about $15,000, and the cost of medical care in the year following the surgery is almost $19,000. The annual cost of lumbar surgery in the U.S. is close to 4.8 billion every year. The outcomes of lumbar surgeries are less than satisfactory. 70% of patients continue to report significant back pain up to 17 years after the first surgery. 66% are still having back pain after the second intervention. And 12% of the patients will experience even more severe back pain after the surgery than prior to it. One of the largest studies conducted a few years ago compared two groups of patients. Both groups had very similar symptoms and almost identical MRI findings. While the patients from the first group had a discectomy, the second group was treated conservatively. 18 months later, the patients from each group reported very similar complains. What is also significant is that failure of surgery to alleviate pain often leads to a snowball effect of different (still invasive) interventions, which are palliative in nature. These procedures are not only expensive, but carry their own risk of potential complications. The list of these procedures includes, but is not limited to radio frequency nerve ablation, electrical nerve stimulation, morphine pump placement, etc. Meanwhile, the patient's disability typically progresses and becomes permanent. It is apparent that the initial doctor's choice of conservative versus surgical treatment often has a life-long impact on the patient's health. The reality remains that many symptomatic patients, especially those with MRI-confirmed disc or foraminal pathology, are never given a fair chance of adequate conservative treatment. Being promised a quick and ultimate relief of their pain by some ambitious and aggressive spinal doctors, numerous patients end up in chronic pain centers for many years to come. While not dismissing the need of surgical involvement for carefully selected group of patients, we constantly observe that the vast majority of low back patients can and must be successfully treated by significantly less intrusive means. In our opinion, a recommendation of neurosurgical intervention should be least balanced by an expert opinion of unbiased conservative-thinking specialist, familiar with non-invasive pain management options. The results of the imaging studies must be always correlated with the results of EMG and, most importantly, thorough clinical examination. (Up to 40% of the patients who had back surgeries, had never been physically examined by a neurosurgeon, and the doctor's decision was solely based on the MRI results). Again MRI findings must not be overestimated or viewed out of context of the whole clinical picture. We offer exactly this type of expertise. Having many years of experience in this field, being board certified in PM&R and dealing with thousands of acute and chronic back pain patients, we strongly feel that our proficiency in evaluation of potential surgical candidates may have an enormously positive impact on the final outcome of their health condition and quality of the patient's lives. It may save tens of thousands of patients from unnecessary surgical intervention, reduce the time of their disability, and therefore be also very cost effective. Suggestions: • Lower back pain patients, for whom neurosurgical intervention is considered, will be referred to one of our group specialists for an evaluation • For the evaluation, the patient must bring all supporting medical documents, including previously done diagnostic test results. • If some of the test results are outdated or absent, we will reserve the right to order new tests (e.g. MRI, CT, EMG, etc.) • If the trial of conventional conservative therapy and pain management protocol are indicated, the patient may be reassessed by one of our physicians 3-6 months later in order to document the patient's progress and confirm the success (or failure) of the initially proposed treatment plan. At the present time our facilities have all the professional and technical resources necessary to start implementing this protocol immediately.
Thorough orthopedic examination and treatment including - joint and soft tissue injections
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