"Surgery to relieve chronic lower back pain is no better than intensive rehabilitation and nearly twice as expensive" concluded researchers in a Reuters article published Monday. The researchers at Nuffield Orthopedic Center in Oxford England studied 349 patients with back pain who either had surgery or intensive rehab.

According to Jeremy Fairbank, an orthopedic surgeon at the center "This is strong evidence that intensive rehabilitation is a good thing to do for people with chronic back pain who are thinking of having about having operations…The ultimate outcome ... is there is not much difference..."

However, the article noted the "average cost for a surgery patient was $14,400, compared to $8,285 for rehabilitation." And this is in Britain, where surgical costs are significantly lower than here in the US. The study looked at patients who had already failed standard "non-operative care", and found that even for those patients, intensive rehab was just as effective as surgery.

The Dartmouth Atlas of Health Care provides another perspective on back surgery rates. In reviewing Medicare discharge data, the folks at Dartmouth have identified widely varying rates of back surgery in different jurisdictions. For example, the back surgery rate in Miami is 1.8/1000 Medicare eligibles, while it is 4.8 in Fort Myers. Why?

Practice pattern variation is the quick answer; a well-documented phenomena wherein treatment choices appear to be based more on the traditions of local practice than on sound medical science.

What does this mean for you?

If you use clinical guidelines, examine those pertaining to back surgery, back pain, and rehab. Undoubtedly payers are paying for more back surgery than they should.