Low Back Surgery and Workers’ Comp: Role of the OM Provider in Helping Patients Make Better Informed Decisions

TRACK: OEM Clinical Practice

Michael Erdil, MD, FACOEM, OEHN/UCHC, Marlborough, MA

Low back pain is a major cause of lost work days and chronic disability. Approximately 10% of cases of work-related low back pain account for 80 to 90 percent of costs, with high costs attributable in part to poor surgical outcomes. This session will review the medical evidence that informs medical specialty evidence based guidelines on surgery for low back pain (including ACOEM, ODG and North American Spine Society) and then review recent studies that show actual trends in treatment of low back pain and low back surgery, along with information about pain and function outcomes, for conditions that do and don’t meet guideline indications. Typical surgical consent procedures review the risks of anesthesia and the actual procedure. True informed decision making would provide the patient with information - in language or graphical format at the patient’s level - about the probable short and long-term benefit, possible short and long-term risks, the alternatives to the proposed procedures, and the likely long-term outcomes of the alternatives. The informed decision making process then engages the patient in a discussion that addresses the patient’s goals, risk tolerance for surgery vs. benefits, and values. Preliminary research on structured informed decision making indicates that patients often make different decisions than anticipated by providers, and that patients engaging in informed decision making may have better clinical outcomes. Until informed decision making with standardized patient education becomes the clinical norm with widespread availability, OEM providers can play a more prominent role in patient education and shared decision making to assist patients with making informed choices. This session will present the evidence regarding non-surgical vs. surgical treatment of lumbar radiculopathy and chronic low back pain due to degenerative disc disease, results of outcomes studies, and evidence for using shared decision making in addition to presenting recommendations for implementing this in OEM practice.