Purpose: Back pain is a significant problem in Europe with important socio-economic impact. The purpose of this study was to evaluate the incidence of spinal surgery for patients with back pain.

Sudy design: This was a retrospective Level II type study. Patient sample included five thousand and forty five patients with a five year follow up.

Methods and results: During past five years 5145 patients were seen in the back pain screening clinic. 823 patients (16%) were referred to the spine clinic (p< 0.001). 127 patients (2.47%) were operated on (p< 0.001). 106 patients (2.1%) had lumbar discectomy/decompression, 9 (0.59%) cervical discectomy, 3 (0.06%) pars reconstruction, 9 (0.17%) fusion and PLIF for spondylolisthesis, 5 (0.1%) decompression for spinal stenosis and 1 (0.01%) subtraction osteotomy for kyphosis. 5 patients (0.1%) were referred with “red flag” symptoms: 4 with spinal stenosis and 1 with tumour. 17 patients (0.3%) had discogram. 4 of them went for surgery: 1 had L4/5 PLIF, 2 L5/S1PLIF and 1 L5/S1 discectomy. 289 patients (5.6%) had nerve root blockade. Following NRB 47 patients (0.9%) had discectomy/decompression (p< 0.001). 62 patients had discectomy/decompression without previous NRB. L5/S1 discectomy was the most common (48 pts; 0.9%). 86 patients (1.7%) had facet joint injections. 8 patients (0.15%) had surgery following FJI (p< 0.001). 1 patient had L4 nerve root decompression, 3 L4/5 discectomy, 1 L5/S1 nerve rot decompression, 1 alartransverse fusion and 1 L5/S1 PLIF. 465 patients (9%) did not have nerve root blocks or facet joint injections. 3 patients (0.06%) had epidural injections of local anaesthetic and steroid.

Conclusion: Spinal surgery is not commonly performed in patients with back pain. Majority of patients can be treated conservatively. Prior to surgery nerve root blocks and facet joint injections are useful in selected patients.

Purpose: Neck disorders, including both neck pain and injuries, are significant and increasing problem worldwide. The purpose of this study was to assess progression and current condition of patients with neck pain five years after initial treatment in the Back Pain Screening Clinic.

Study design: This study was a randomised cohort Level I study. We randomly selected and reassessed one hundred patients with the neck pain who were treated conservatively out of the first one thousand of patients seen in our clinic five years ago. Outcome measures included SF36 (PCS and MCS), ODI, VAS, HA and DS scores.

Methods and results: One hundred randomly selected patients were interviewed and assessed for initial complaint, progression of symptoms, time out of work, litigation, other treatments and BPSC treatment satisfaction. BPSC treatment consisted of the patient assessment, advice, education, reassurance or course of physiotherapy. All of the patients were treated conservatively. 46 male and 54 female patients with mean male age 44.85 years (SD=14.43) and mean female age 48.56 (SD=15.39) were included in the study. In 72 patients pain started spontaneously. 15 patients had pain related to industrial injury/RTA. 6 patients were excluded from the study (4 with no data available, 1 child, 1 death). Mean time out of work for patients with spontaneous onset pain was 3 weeks (SD 1.12) and for patients with industrial injury/RTA 29.24 weeks (SD 20.92) (p=0.003). Analyzing outcome measures first vs 5y showed: SF36 PCS mean 30.04 vs 51.24 (SD 7.18 vs 6.38) (p< 0.001), MCS mean 30.63 vs 53.0 (SD 11 vs 6.10) (p< 0.001), ODI 41.72 vs 13.22 (SD 19.65 vs 8.41) (p< 0.001), HA mean 8.72 vs 2.37 (SD 4.54 vs 1.32) (p< 0.001), DS mean 6.71 vs 2.01 (SD 4.12 vs 1.20) (p< 0.001) and VAS mean 4.32 vs 0.84 (SD 2.18 vs 1.03) (p< 0.001). Using the patient satisfaction questionnaire, 93% of patients found BPSC treatment useful.

Conclusion: Significant symptomatic improvement is found in this cohort group of patients five years after initial treatment in BPSC. Time out of work is significantly increased in patients pursuing litigation compared with patients with spontaneous onset of neck pain (3/52 vs 29.24/52, p=0.003).

Purpose: Study purpose was to assess progression and current condition of patients with back pain five years after initial conservative treatment in BPSC.

Methods and results: 100 from the first 1000 patients were randomly selected. 46 male mean age 44.85 and 54 female patients mean age 48.56 years were assessed by interview and questionnaires for symptoms progression, time out of work, litigation, other treatments and treatment satisfaction. In 72 patients pain started spontaneously. 15 had pain related to industrial injury/RTA. 3 patients had neck pain and 3 lower back pain related to sports injury. 3 females had postpartum back pain. 6 patients were excluded from the study (4 no data available, 1 child, 1 death). Mean time out of work for patients with spontaneous back pain was 3.07 weeks (SD 1.83) and for patients with industrial injury/RTA 23.42 weeks (SD 39.92) (p=0.003). Analyzing outcome measures 1 vs 5y showed: SF36 PCS mean 31.99 vs 50.53 (SD 7.38 vs 6.28) (p< 0.001), MCS mean 37.63 vs 53.0 (SD 11.10 vs 6.15) (p< 0.001), ODI 40.71 vs 13.94 (SD 20.65 vs 9.41) (p< 0.001), HA mean 8.81 vs 2.96 (SD 4.64 vs 1.91) (p< 0.001), DS mean 6.51 vs 2.26 (SD 4.32 vs 1.40) (p< 0.001) and VAS mean 4.01 vs 0.94 (SD 2.08 vs 1.23) (p< 0.001). 93% patients found BPSC treatment useful.

Conclusion: Significant symptomatic improvement is seen in patients five years after initial BPSC treatment. Time out of work is significantly increased in patients pursuing litigation compared with patients with spontaneous onset of back pain.

Purpose: Purpose of the study was to evaluate the incidence of spinal surgery for patients with back pain.

Methods and results: During past five years 5145 patients were seen in the back pain screening clinic. 823 patients (16%) were referred to the spine clinic (p< 0.001). 127 patients (2.47%) were operated on (p< 0.001).106 patients (2.1%) had lumbar discectomy/decompression, 9 (0.59%) cervical discectomy, 3 (0.06%) pars reconstruction, 9 (0.17%) fusion and PLIF for spondylolisthesis, 5 (0.1%) decompression for spinal stenosis and 1 (0.01%) subtraction osteotomy for kyphosis. 5 patients (0.1%) were referred with “red flag” symptoms: 4 with spinal stenosis and 1 with tumour. 17 patients (0.3%) had discogram. 4 of them went for surgery: 1 had L4/5 PLIF, 2 L5/S1PLIF and 1 L5/S1 discectomy. 289 patients (5.6%) had nerve root blockade. Following NRB 47 patients (0.9%) had discectomy/decompression (p< 0.001). 62 patients had discectomy/decompression without previous NRB. L5/S1 discectomy was the most common (48 pts; 0.9%). 86 patients (1.7%) had facet joint injections. 8 patients (0.15%) had surgery following FJI (p< 0.001). 1 patient had L4 nerve root decompression, 3 L4/5 discectomy, 1 L5/S1 nerve rot decompression, 1 alartransverse fusion and 1 L5/S1 PLIF. 465 patients (9%) did not have nerve root blocks or facet joint injections. 3 patients (0.06%) had epidural injections of local anaesthetic and steroid.

Conclusion: Spinal surgery is not commonly performed in patients with back pain. Majority of patients can be treated conservatively. Prior to surgery nerve root blocks and facet joint injections are useful in selected patients.