What Do We Know?

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There are many things that we do not know about low back pain or chronic pain.  Yet there are many facts that are clear.  Here is a list of what we know:

  • Exact diagnosis of LBP is usually unclear
  • Discs normally degenerate with age
    • Little association as a cause of low back pain
  • Prognosis for return to work worsens with increasing time off of work
  • Depressed patients are more disabled
  • History of past abuse worsens prognosis
  • Prognosis is worse in patients on worker’s comp
  • Patients in chronic pain become sensitized to pain
  • Repeated spine surgeries have decreasingly positive outcomes with each operation
  • Psychological profile is a better predictor of the success of surgery than the anatomic lesion
  • Surgeons have a limited capacity to assess patients’ stress levels
  • Real success rate of lumbar fusion is overestimated
  • Structured non-operative care can be successful
  • Downside of a failed back surgery can be severe
  • Insurance doesn’t pay for aggressive structured care

It is critical that you understand the current thinking of the spine surgery community. Spine surgery for the appropriate reasons has a wonderful success rate.  Surgery for ill-defined indications is unpredictable and can be catastrophic.  Be careful!