The North American Spine Society released a list of specific tests and treatments commonly ordered but not always necessary as part of the Choosing Wisely campaign.
The campaign, an initiative of the ABIM Foundation, identifies evidence-based recommendations that could support conversations between patients and physicians about the most appropriate care based on the patient's individual circumstances.
NASS appointed a multidisciplinary task force to identify five areas to make recommendations based on scientific evidence, existing clinical practice recommendations and expert opinion. The NASS Board of Directors has approved this list. The five items on the list include:
1. Don't recommend advanced imaging of the spine within the first six weeks in patients with non-specific acute low back pain in the absence of red flags.
2. Don't perform elective spinal injections without imaging guidance, unless contraindicated.
3. Don't use bone morphogenic protein for routine anterior cervical spine fusion surgery.
4. Don't use electromyography and nerve conduction studies to determine the cause of axial lumbar, thoracic or cervical spine pain.
5. Don't recommend bed rest for more than 48 hours when treating low back pain.
"Because back pain is so prevalent and debilitating, desperate patients flock to their spine specialists' offices armed with advice and anecdotes from well-meaning family, friends and online sources," said F. Todd Wetzel, MD, NASS Choosing Wisely Task Force Chair and Professor and Vice Chair for the Department of Orthopedic Surgery and Sports Medicine and Professor of Neurosurgery at Temple University School of Medicine in Philadelphia, in the organization's news release. "We hope this list of recommendations will help spine care providers and their patients cut through the noise and make informed care decisions together."
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