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Surgical management of low back pain

Spinal surgery for chronic low back pain is controversial, and the disproportionate number of fusions in private hospitals is unexplained

In developed countries, low back pain is the most common presenting symptom in primary care practice, with a lifetime prevalence of 80% for episodes of back pain.1 It affects adolescent sportsmen, pregnant women, hospital nurses and middle-aged labourers, and it peaks in the elderly.1 Back pain disrupts the rhythm of daily life, affecting work, recreation, social life and family income. The level of disability has a significant cost to the community.

There is an encyclopaedic range of medical and alternative treatments for low back pain. Most have, at best, limited benefits.2 Disappointed patients resort to nerve blocks and ablative rhizotomies which also have limited evidence for long-term benefits.3

Armed with mobile phones, consumed with social media, and with rapid access to online information, our patients present with high expectations of modern technology, including surgery. With outstanding results from hip and knee arthroplasties, they expect similar results from spinal surgery. Not uncommonly, the patient attends the surgical consultation with an expectation that the problem scan be fixed.


At the initial…