Conservative Therapy Policy

Conservative Therapy Policy

PURPOSE

It is the goal of Inspired Spine to provide surgical solutions for chronic back pain problems. For most people, any episode of lower back pain will tend to get better within two weeks to three months. During this time period that an episode of back pain is resolving, or if the back pain is chronic, it is important to consider the appropriate course of conservative (meaning non-surgical) treatment in order to:

 

  • Reduce pain and spasm
  • Provide conditioning for the back
  • Assist in managing issues frequently associated with back pain, such as sleeplessness or depression.

 

Treatment options are considered “conservative” when they are non-invasive (such as medication) or markedly less invasive (such as injections, physical therapy, physical rehabilitation, or chiropractic manual manipulation) than surgery.

 

As a general rule, surgery for lower back pain is considered if conservative back treatment fails and the lower back pain and/or leg pain persists for an extended period of time, or if the patient is unable to maintain a satisfactory ability to function in everyday activities. The goal of this policy is to ensure that conservative treatment options are explored prior to surgery with each patient.

 

Obviously there are other considerations in certain clinical situations including but not limited to frank instability, significant weakness, that may  cause permanent deficit without immediate surgical intervention, so this policy is guideline for surgery for lower back pain without significant neurological deficit.

POLICY:
      1. A DOCTOR will see all patients prior to the patient consulting with the surgeon group. The purpose of this initial assessment is to determine if the patient is a surgical candidate.
      2. In the event that surgery may be an option, it is the responsibility of the DOCTOR to ensure conservative measures have been taken.
        • Current Imaging must be ordered and/or reviewed
        • Physical Therapy/Rehabilitation must be met. Criteria:
          • Cervical—6 weeks of 2 times a week
          • Thoracic—8 weeks of 2 times a week
          • Lumbar—12 weeks for 2 times a week
        • Injections options must be explored including ESI, MBB, Facet injections, Nerve root injections, SI joint injections and such
        • Brace options including LSO, TLSO and collar sets should be explored for appropriateness. This is mostly the case  when specific activities  like riding IN A car  provoke symptoms and contributing  to ongoing damage of the spine/disk/Facet. Except for instability we will communicate with patient  and  bracing is only for specific activities the reduce the stress from spine and a continuous bracing  leads to weakening of paraspinal muscle and is contra indicated.
        • Smoking cessation must be discussed, as well significant higher surgical, anesthesia, recovery, prognosis with smokers.
        • Narcotics and mental health evaluation completed and reviewed. Secondary gain considered and ruled out.
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