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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Second opinion for degenerative spinal conditions: an option or a necessity? A prospective observational study

Authors: Mario Lenza, Rachelle Buchbinder, Margaret P. Staples, Oscar F.P. dos Santos, Reynaldo A. Brandt, Claudio L. Lottenberg, Miguel Cendoroglo, Mario Ferretti

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Second opinions may improve quality of patient care. The primary objective of this study was to determine the concordance between first and second diagnoses and opinions regarding need for spinal surgery among patients with back or neck pain that have been recommended spinal surgery.

Methods

We performed a prospective observational study of patients who had been recommended for spinal surgery and received a second opinion between May 2011 and May 2012 at the Hospital Israelita Albert Einstein on the advice of their health insurance company. A physiatrist and orthopaedic surgeon independently performed the second assessment. If both agreed surgery was indicated, or consensus could not be reached, participants attended a spine review panel for a final recommendation. Descriptive analyses compared diagnoses and management plans of the first and second opinions.

Results

Of 544 referred patients, 16 (2.9%) did not meet inclusion criteria, 43 (7.9%) refused participation and 485 were included. Diagnoses differed from the first opinion for 290 (59.8%). Diagnoses of cervical and lumbar radiculopathy were concordant in 36/99 (36.4%) and 116/234 (49.6%) respectively. The second opinion was for conservative treatment for 168 (34.6%) participants, 27 (5.6%) were not considered to have a spine condition, and 290 (59.8%) were referred to the review board. 60 participants did not attend the board review and therefore did not receive a final recommendation. Board review was conservative treatment for an additional 67 participants, 20 were not considered to have a spine condition and 143 participants were recommended surgery. Overall, 33.6% received a final opinion of surgery (143/425) although only 66 (15.5%) received the same surgical recommendation, 235 (55.3%) were advised to have conservative treatment, and 47 (11.1%) were not considered to have a spinal diagnosis.

Conclusions

We found a large discordance between first and second opinions regarding diagnosis and need for spinal surgery. This suggests that obtaining a second opinion could reduce potentially unnecessary surgery.

Trial registration

Current Controlled Trials ISRCTN07143259. Registered 21 November 2011.
Literature
1.
Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800.CrossRefPubMedCentral
2.
3.
Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ. Outcome of low back pain in general practice: a prospective study. BMJ. 1998;316(7141):1356–9.CrossRefPubMedPubMedCentral
4.
5.
6.
Stranges E, Russo CA, Friedman B. Procedures with the Most Rapidly Increasing Hospital Costs, 2004–2007: Statistical Brief #82. 2009 Dec. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); 2006 Feb-. Available from http://​www.​ncbi.​nlm.​nih.​gov/​books/​NBK53597/​.
7.
Katz JN. Lumbar spinal fusion. Surgical rates, costs, and complications. Spine (Phila Pa 1976). 1995;20(24 Suppl):78S–83S.CrossRef
8.
Gray DT, Deyo RA, Kreuter W, Mirza SK, Heagerty PJ, Comstock BA, et al. Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine (Phila Pa 1976). 2006;31(17):1957–63. discussion 1964CrossRef
9.
Kidane B, Gandhi R, Sarro A, Valiante TA, Harvey BJ, Rampersaud YR. Is referral to a spine surgeon a double-edged sword?: patient concerns before consultation. Can Fam Physician. 2011;57(7):803–10.PubMedPubMedCentral
10.
Vashitz G, Pliskin JS, Parmet Y, Kosashvili Y, Ifergane G, Wientroub S, et al. Do first opinions affect second opinions? J Gen Intern Med. 2012;27(10):1265–71.CrossRefPubMedPubMedCentral
11.
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–300.CrossRefPubMedPubMedCentral
12.
13.
Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, et al. American Association of Neurological Surgeons/Congress of Neurological Surgeons. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. 2005;2(6):673–8.CrossRefPubMed
14.
15.
16.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–83.CrossRefPubMed
17.
Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976). 1983;8(2):141–4.CrossRef
18.
Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation, adaptation and validation of the Roland-Morris questionnaire--Brazil Roland-Morris. Braz J Med Biol Res. 2001;34(2):203–10.CrossRefPubMed
19.
Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271–3.PubMed
20.
Vigatto R, Alexandre NM, Correa Filho HR. Development of a Brazilian Portuguese version of the Oswestry disability index: cross-cultural adaptation, reliability, and validity. Spine (Phila Pa 1976). 2007;32(4):481–6.CrossRef
21.
Grotle M, Brox JI, Vollestad NK. Concurrent comparison of responsiveness in pain and functional status measurements used for patients with low back pain. Spine 1976. 2004;29(21):492–501.CrossRef
22.
Deis N, Findlay JM. Appropriateness of lumbar spine referrals to a neurosurgical service. Can J Neurol Sci. 2010;37(6):843–8.CrossRefPubMed
23.
24.
25.
26.
27.
28.
29.
Carragee EJ, Hannibal M. Diagnostic evaluation of low back pain. Orthop Clin North Am. 2004;35(1):7–16.CrossRefPubMed
30.
van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17;2:CD007431. doi:10.​1002/​14651858.​CD007431.​pub2.
31.
Waddell G, Main CJ, Morris EW, Venner RM, Rae PS, Sharmy SH, et al. Normality and reliability in the clinical assessment of backache. Br Med J (Clin Res Ed). 1982;284(6328):1519–23.CrossRef
32.
Wassenaar M, van Rijn RM, van Tulder MW, Verhagen AP, van der Windt DA, Koes BW, et al. Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012;21(2):220–7. doi:10.​1007/​s00586-011-2019-8.CrossRefPubMed
33.
34.
Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, et al. American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976). 2009;34(10):1066–77. doi:10.​1097/​BRS.​0b013e3181a1390d​.CrossRef
35.
36.
Metadata
Title
Second opinion for degenerative spinal conditions: an option or a necessity? A prospective observational study
Authors
Mario Lenza
Rachelle Buchbinder
Margaret P. Staples
Oscar F.P. dos Santos
Reynaldo A. Brandt
Claudio L. Lottenberg
Miguel Cendoroglo
Mario Ferretti
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1712-0

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