Thousands of Canadians with severe back and neck pain face agonizingly long waits to see spine surgeons, only to learn they didn’t need to go in the first place, creating mounting frustration and costing millions of dollars.
The reality is that back pain is common and that high-tech tests ordered by doctors often find abnormalities that have nothing to do with the symptoms – but lead to a referral to a spine surgeon. The wait can be up to a year or more, and then the surgeon frequently has nothing to offer except advice to exercise, get physiotherapy or use back supports.
Experts say the remedy isn’t to throw more money at the system but to triage patients so those who potentially require operations see surgeons and those who don’t get the care they need. That solution will not only prevent patients from lining up in the wrong queue but stop massive health-care waste – $24-million annually on unnecessary MRI and CT scans in Ontario alone – creating a logjam for people such as Barbara Gamsby, who needs to see a surgeon for a spinal decompression and fusion.
“When I have the pain really bad, it’s just unbearable,” said Ms. Gamsby, of Guelph, Ont. “You shake, you can’t think, you quiver all over and you take as many drugs as you are allowed to take to ease the pain.”
She has waited two years in abject pain: one year to see the surgeon and another for an operation to repair spinal stenosis, a narrowing of the spinal column, plus spondylolisthesis, a condition where a bone in the lower part of the spine slips forward every time she walks. Once a champion curler and avid golfer, the 71-year-old is unable to walk for long, has difficulty standing and can’t do household chores.
The avalanche of back- and neck-pain patients has caused a ripple effect: Half of Canada’s spine surgeons – 60 out of 120 – have closed their practices to new patients at some point, according to Hamilton Hall, executive director of the Canadian Spine Society, who described the system as being in a “terrible mess.” Many others have restricted their practice, only accepting select patients.
“In an unscreened practice, where the surgeon sees 100 patients, no more than 10 would be surgical candidates,” Dr. Hall said. “As a surgeon wanting to do surgery, I don’t want to see 90 people who don’t need me.”
The cause, in part, is the very technology that was supposed to help diagnose the problem. While MRI and CT scans are often used with back and neck pain, they carry a 60-per-cent false positive rate – the tests often reveal abnormalities unrelated to the pain and typical in people over the age of 40.
“As a screening tool for back pain,” Dr. Hall said, “MRIs are worse than useless.”
The overwhelming majority of patients sent to spine surgeons require specific exercises, physiotherapy, education and a hot or cold pack. General wear-and-tear injuries or aching joints aren’t operable conditions, even though they may cause a lot of pain, Dr. Hall said.
Operable conditions are those involving nerve symptoms or spines with abnormal movement that require stabilization, he said.
For patients, the waits are onerous on two levels: first for that initial appointment with a surgeon, where many find they have queued for naught; and second for those who do require surgery and now have to wait again.
Nova Scotia and New Brunswick have the longest waits – nine months – for that first appointment to see a spine specialist; followed by Alberta at eight; Manitoba and Saskatchewan at seven; Ontario and British Columbia at six. Newfoundland and Labrador have the shortest waits at four months, according to Dr. Hall. Waits for surgery vary across Canada from months to years, save for emergency and urgent cases that are quickly seen.
