A survey, published in Canadian Family Physician, has found that a substantial number of patients with degenerative spinal conditions who are referred to a spine surgeon are incorrectly concerned that surgery is inevitable.
Authors Kidane et al surveyed 309 patients with non-emergent spinal conditions who had been referred by their primary care physician to a spine surgeon. Nearly half (47%) of those surveyed listed fear of surgery as one of their top three concerns and in this subgroup, there was no statistical difference between patients who were candidates for surgery and those who were not candidates for surgery (41.2% vs. 35.6%, respectively). Furthermore, only 14.9% of all patients had actually had surgery or had been booked for surgery one year after completing the survey (only 22.7% after 24 months).
Raja Rampersaud, associate professor at the University of Toronto and one of the study investigators, said that this finding highlighted the need for primary care physicians to provide more specific information to patients when referring them for surgery. “As noted in the article, decision making around surgical intervention for spinal symptoms is rarely black and white; thus, it is not something that we [as spine surgeons] can expect our primary care colleges to provide a great amount of information on to our patients. However, sending clear messages to patients about the reasons for referral (eg, clarity in diagnosis, further advice on directions for management etc.) at the primary care stage is important. It seems that a referral to a spine surgeon infers to patients that there is a need for surgery — although, surgery is performed in less than 10% of patients. Therefore, simple education in this regard (eg, surgery may be an option to consider) would be helpful. Obviously, this message does not apply to emergent spinal symptoms.”
Aside from fear of surgery, patients in the survey were also concerned about ongoing pain, loss of function, and the permanence of symptoms. According to Rampersaud, such concerns can worsen symptoms. “Anxiety can further amplify symptoms, particularly pain, which in turn causes more anxiety.”
For the spine specialist who is faced with a patient with concerns, a basic tenant of care, Rampersaud said, is to ask patients about their concerns (above and beyond the obvious pain and disability) and address these accordingly. “The majority of the time it is simply reassurance. The bigger problem is that many spinal complaints are not curable and recurrence or persistence of symptoms is actually quite common (although not dangerous) and individuals need help in learning how to manage their symptoms in the long term rather than looking for the quick fix.”