Multidisciplinary Collaboration Prevents Overuse of Spinal Fusion Surgery

Patients diagnosed with lumbar degenerative spine disease are more likely to receive the right care when a team of experts representing multiple medical specialties collaborate in reviewing the patient’s needs and determining the best treatment option.
 
This is the finding of a study at the Virginia Mason Spine Clinic, titled “Multidisciplinary Evaluation Leads to the Decreased Utilization of Lumbar Spine Fusion: An Observational Cohort Pilot Study” and published by the journal, Spine, in January.
 
In this study, a total of 137 patients referred to Virginia Mason over a 10-month period for consideration of spinal fusion were reviewed by a multidisciplinary panel of physiatrists, neurosurgeons, nurses, physician assistants, pain specialists, orthopedic spine surgeons, anesthesiologists and physical therapists. Of those patients, 100 had been recommended for lumbar spine fusion by a surgeon outside Virginia Mason. After reviewing medical charts and other information for each patient, the panel of Virginia Mason experts determined that a non-operative treatment—instead of surgery—was more appropriate for 58 percent of the patients.
 
Isolated surgical decision-making can result in inappropriate treatment that is a disservice to patients, a waste of health care sources, and an unnecessary cost for the patient and the provider. By comparison, multidisciplinary collaboration that engages experts from multiple specialties is more likely to result in the appropriate use of surgical and non-surgical treatment options, the study concluded.
 
“Involving representatives of different medical disciplines in decision-making is essential to ensuring the quality of spine care, decreasing the overutilization of surgery, and improving the patient’s experience,” said Rajiv Sethi, MD, medical director, Virginia Mason Neuroscience Institute, and co-author of the study.
 
The multidisciplinary team approach is a standard process at the Virginia Mason Spine Clinic.

Lumbar spine fusion, a surgical treatment for acute lower back pain, uses bone graft to allow two vertebrae to grow into one bone. The significant increase in spinal fusion procedures in the United States over the past two decades has fueled questions about whether this surgery is overused when other treatment options could benefit patients.
 
“We strive to provide our patients the right care at the right time,” Dr. Sethi said. “Accomplishing this requires a team approach—including multidisciplinary conversations that empower all team members—focused on each patient’s unique needs. Surgery is not always the best nor most appropriate treatment.”