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    Doctors Overly Optimistic About Back Surgery

    Careful Patient Selection Needed, Says Surgeon

    Psychosocial Factors Important

    The study is not the first to find that surgery is not the cure-all for low-back pain that many patients think it is, or the first to suggest that doctors do a poor job of predicting which patients will benefit the most from back surgery.

    Research presented last winter at the annual meeting of the American Academy of Orthopaedic Surgeons found that factors such as patient education level, depression, smoking, and whether or not a patient had filed a workers' compensation claim all affected surgical results among low-back-pain patients.

    A researcher of that study, William Abdu, MD, tells WebMD that surgeons need to be aware that a host of physical, psychological, and social issues unrelated to back pain can influence surgical results.

    "There is a tendency among patients to think that if they have an operation everything will be normal," he says. "But the more medical and psychosocial [issues] a patient has, the lower the expectations for surgery should be."

    Most Patients Are Poor Candidates

    Orthopaedic surgeon Jeffery C. Wang, MD, agrees that doctors need to take medical and psychological issues into consideration when deciding whether a patient will benefit from back surgery.

    Wang is chief of the spine service for the UCLA department of orthopaedic surgery and a spokesman for the American Academy of Orthopaedic Surgeons.

    "The key to any successful surgery is patient selection," he tells WebMD, adding that psychologically distressed patients who otherwise appear to be good candidates for back surgery often have poor surgical results.

    Wang says less than 10% of patients with low-back pain are appropriate surgical candidates. And he acknowledges that there are probably too many back surgeries being performed.

    "There are certainly doctors who are performing too many surgeries, but that certainly isn't true of everyone," he says. There are very good studies out there showing that if you select the right patient for the right surgery, outcomes are very good."

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