TRENDS IN THE MANAGEMENT OF POSTOPERATIVE LOW BACK PAIN

Abstract

This study sought to determine the post-operative management of spinal patients in the UK, and to determine if uniformity exists between surgeons and if there is any published evidence for this practice.

A reply-paid questionnaire was sent to members of the British Association of Spinal Surgeons and the Society for Back Pain Research. The questionnaire documented the surgeon’s experience, where they work, their operative population, the types of spinal surgery performed, and whether they have a routine for post-operative management or any written instructions for patients concerning post operative management. It also asked about the nature and duration of professionally supervised rehabilitation. Of the 89 questionnaires distributed, 63 (71%) were returned, of which 51 could be used in the analysis. The 12 not used were either completed incorrectly, had missing data or the surgeon had since retired. The replies demonstrated wide variation: only 35% of surgeons provide their patients with written post-operative instructions; there was limited referral to physiotherapy, with only 45% referring to a physiotherapist (for an average of 1.8 sessions); only a modest fraction of surgeons advocated the use of a post-operative corset (18%), others restricting sitting or encouraging bed rest; and a range of recommendations regarding return to work. There was also only a limited correlation between restrictions on sitting and recommendations about return to sedentary work or driving (Spearman r=0.08 and 0.36, respectively).

In summary, although individual surgeons may be certain of their practice, the overall variation indicates ongoing uncertainty across the profession. This was further substantiated by our literature search, which revealed limited evidence for current practices, and a paucity of research into postoperative management.