Inappropriate partnersBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4439 (Published 24 August 2010) Cite this as: BMJ 2010;341:c4439
- Mark J Turtle, consultant anaesthetist and pain management specialist1
The pursuit of a surgical solution to a problem such as spondylosis whose pathology is poorly understood is frustratingly disappointing. “First do no harm” should drive decision making in clinical practice, yet clinicians still seem besotted with the idea that surgery is the answer to back pain.
Fouyas and colleagues admit the paucity of evidence to justify surgery as a therapeutic option for cervical spondylosis even with neurological dysfunction.1 This lack is all the more notable when long term follow up is considered to be five years, whereas patients with spinal pain commonly live with their predicament for 5-10 times longer than this.2 The mistake is assuming a direct relation between symptoms and structural deviation as shown by investigations such as magnetic resonance imaging. In fact, many people, perhaps everyone if age for age comparisons were made, have such changes, which are often associated with either insignificant or accepted symptoms.3
Surgery produces irreversible change even without unwanted and unexpected effects. It hungrily consumes healthcare resources. It promulgates and reinforces the widely accepted idea that a medical model is the most efficient in managing chronic disease.4 This philosophy is a large obstacle to the reform of health care, if not universally, certainly in the Western world.
Aggressive analgesia, closely followed by paced, functional restoration of activity and completion of tasks while addressing relevant psychosocial factors is a logical pattern of care. It is low risk and probably more efficient in its consumption of healthcare resource.5
Cite this as: BMJ 2010;341:c4439
Competing interests: None declared.