Spine surgery video supports concept of shared decision-making between doctors, patients

Sep 20 2011
An informational video on spine surgery proved helpful for patients deciding how to approach back pain caused by herniated discs, spinal stenosis and degenerative spinal disease.

Though conservative treatments are best, some situations cannot avoid surgery. The three most common surgical procedures are discectomy, spinal fusion and decompression, which is also referred to as laminectomy, according to the American Academy of Orthopaedic Surgeons. These operations are often associated with conditions in which structures in the spine are damaged or put pressure on the surrounding nerves.

A discectomy removes part or all of an intervertebral disc that degenerated or may be putting pressure on the spinal cord. A laminectomy excises part of the vertebrae in order to widen sections of the spinal column, which also takes pressure off the nerves. Both of these operations may be performed together or followed by fusion surgery, which melds different vertebrae together using bone grafts or proteins in order to stabilize movement, according to the National Institutes of Health.

Researchers at Dartmouth Medical School conducted an experiment to see how patients with lower back pain would react to an informational video about evidence-based treatments, both surgical and non-surgical, and see if it altered any initial preferences they had. Eighty-six percent of subjects opted to watch the video, and the results were published in Spine.

Compared to non-viewing subjects, those who watched were more likely to change their minds about the treatment plan they wanted before. Thirty-eight percent of people who watched the video re-evaluated their previous opinion. By comparison, only 21 percent of patients who did not watch the video reversed their preference over the course of the experiment. Those who watched the video were also more likely to stick to their original decision than non-viewers, according to the researchers.

Out of all the patients who watched the video without having a treatment preference, 27 percent opted for non-surgical treatment, while 22 percent went the other way. The remaining 51 percent remained undecided. The observation that individuals did not seem to sway exclusively in one direction or the other implies that the video was very balanced in its presentation, said study author Jon Lurie, M.D.

The study supports the idea of shared decision-making between doctors and patients, the researchers said. This approach to situations in which several medical options are available can reduce conflict and ensure that patients are actively involved in their treatment.

Non-surgical treatments for lower back pain may include acupuncture and massage therapy.