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Spine Surgery: Why the Waits are So Long

The Question: After years of lower back pain, I have been referred to a spine surgeon. How long will it be until I undergo surgery?

The Answer: Once referred by a family physician, it can take a year to see a surgeon, according to Albert Yee, a spine surgeon here at Sunnybrook, who hears this question from patients all the time.

However, for patients whose medical problems are more urgent, they can be seen in one month. Either way, that wait represents the time to see a specialist. There is another wait – in Dr. Yee’s case about three to six months – for the actual operation.

“One of the things we ask is whether there is an operation we can perform with a reasonable likelihood of meeting their expectations,” Dr. Yee said in an interview.

Operable conditions include those to repair spines that are producing abnormal movement and require stabilization or relieve patients of nerve symptoms such as sciatica.

Waits for spine surgery can be lengthy in Canada, due to referral methods and the all-too-common presence of disabling back pain among the population.

In Dr. Yee’s practice for example, 934 patients were referred to him over a one-year period, ending in late September 2012. Of those, 458 were or will be scheduled for an assessment, 322 were redirected to a colleague after being referred and a further 154 did not have complete referral information that was requested.

“The current health care wait time environment remains challenging, particularly regarding appointments to see a specialist. It is not uncommon that a referring physician sends referrals to six or seven surgeons of the same patient so as to have them accommodated in the earliest clinic,” said Dr. Yee, Co-director of University of Toronto’s Department of Surgery Spine Program.

Patients eligible for surgery represent a fraction of those referred to spine surgeons: only two out of 10 are surgical candidates – something not unique to Dr. Yee. The remaining eight patients still require another form of treatment such as physiotherapy, specific exercises, or referral to another non-surgical spinal specialist physician.

In some ways, technology has made the matter more complicated. MRI and CT scans, used for neck and back pain, carry a 60 per cent false positive rate. Tests often reveal abnormalities that are typical in those aged 40 and older and are unrelated to the pain they are experiencing. So the very technology that is used to diagnose back related symptoms can also detect changes that don’t require a surgical intervention or any type of medical treatment.

An MRI done on a back, for example, will report an entire page of abnormalities, according to Dr. Yee, none of which may require a remedy.

“A lot of pain is related to wear and tear,” said Dr. Yee, noting that 80 per cent of people will have an episode of chronic mechanical low back pain, lasting about three or so months in their lifetime. Of those, 80 per cent will get better on their own.

“Usually, they are so happy they have the chance to be here,” said Dr. Yee, Associate Professor in the Department of Surgery at the University of Toronto. “They are also very frustrated by the future wait for surgery or frustrated they are not able to do anything. They need to realize too that their symptom constellation may change.”

So, in answer to your question, once you have seen the surgeon – which can take up to a year – it can take a few months for surgery but chances are, you may not be a surgical candidate and an operation may not be the fix for your pain related symptoms. At least you will have started to learn what treatments are available to help abate the pain.

About the author

Lisa Priest

Lisa Priest

Lisa Priest is the Director and Patient Engagement Lead of the North East Toronto Health Link.

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