9-10 a.m. Who Needs Back Surgery" Richard A. Deyo, MD, MPH
Several lines of evidence suggest we may be doing too much back surgery in the United States. The evidence that this may be true includes expert opinion, comparison with other countries, geographic variations in surgery rates within the US, rapid increases in certain types of surgery, patient outcomes in areas with high or low surgical rates, and the preferences of patients when they are well informed.
According to Deyo, surgery offers better relief from leg pain, or sciatica, than from back pain. Whether it helps people who have back pain alone is controversial.
Even in situations where surgery is likely to be of benefit, there is a choice, and reasonable people may choose for or against surgery depending on their own preferences and values, Deyo continues. Patients should be involved in the decision-making.
Back surgery is not helpful for everyone with low back pain; only those with some very specific conditions who also have leg pain with their back pain may benefit. Even then, surgery rarely offers a complete cure, and a choice of either surgical or non-surgical treatment is usually reasonable. Patients should understand that even people without back problems/pain often have abnormal MRI scans of the spine, so an abnormality doesn't necessarily mean surgery is going to help. Surgery is only likely to help if the MRI images match up with specific symptoms and findings on a doctor's examination. It's always wise to consider a second opinion when back surgery is recommended, he concludes.
11-11:30 p.m. Quality Patient Care, AMA President Nancy Nielsen, MD, PhD
As a champion of medical quality, Nielsen represents the AMA on initiatives including the National Quality Forum, the AMA Physician Consortium for Performance Improvement, and the Ambulatory Care Quality
|Contact: Amy Jenkins|
American Academy of Pain Medicine