Low back pain management [Neurosurgery Wiki]

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====== Low back pain management ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1Z3442Lm0S4bVKy1EkjJYddQOCN3mWBU3E6y71GvgZyasvDQHh/?limit=15&utm_campaign=pubmed-2&fc=20250703020926}}


see [[Low back pain diagnosis]].

see [[Low back pain treatment]].

===== Prospective diagnostic concordance studies =====

In a secondary analysis of [[RCT]] comparing diagnostic & management [[decision]]s  
Janny Mathieu et al.  
from:
  - Université du Québec à Trois‑Rivières, Trois‑Rivières, QC, Canada  
  - CIUSSS‑MCQ, Trois‑Rivières, QC, Canada  
  - Division of Neurosurgery, Faculty of Medecine, Université de Montréal, Montréal, QC, Canada.  
  - Université de Sherbrooke, Longueuil, QC, Canada  
  - Balgrist University Hospital, Zurich, Switzerland  
  - University of Zurich Spine Centre, Zurich, Switzerland  
  - University of Toronto, Toronto, Canada  
published in [[Scientific Reports]]  
to assess [[agreement]] in diagnosis and management between [[chiropractor]]s and [[neurosurgeon]]s for patients referred for [[Low back pain]] [[consultation]].  
Diagnostic [[concordance]] was moderate (74.7%, κ = 0.51), management concordance strong (82%), suggesting [[chiropractor]]s are competent for triage of non‑surgical low back pain, potentially easing surgical consult load 
((Mathieu J, Beauséjour M, Châtillon CÉ, O'Shaughnessy J, Tétreau C, Hincapié CA, Schweinhardt P, Descarreaux M, Marchand AA. Diagnostic and management concordance between chiropractors and neurosurgeons for patients with low back pain. Sci Rep. 2025 Jul 2;15(1):23248. doi: 10.1038/s41598-025-04529-9. PMID: 40603946.))
----
**Critical review**:  

- **Strengths**:  
  - Real‑world, clinically relevant sample (mean age ~60, N=101).  
  - Direct comparison with neurosurgeons using standardized categories.  
  - Good statistical rigour with κ, CI, p‑values reported.  

- **Limitations**:  

  - Secondary RCT analysis; original trial focused on triage communication, not concordance.  
  - Moderate κ value indicates appreciable diagnostic disagreement.  
  - Setting: tertiary spine clinic—referral bias and limited generalizability to primary care.  
  - Chiropractors less often labeled non‑specific LBP (31.6% vs neurosurgeons 43.2%, p = 0.02), which may reflect over‑triage or differing diagnostic threshold  
  - [[Blinding]] unclear; could influence neurosurgeon assessments.  
  - No clinical outcomes or patients’ care trajectory data presented here.

**Final verdict (score: 6/10)**  

This well‑performed [[concordance study]] supports the potential [[role]] of chiropractors in neurosurgery [[triage]] pathways. However, moderate diagnostic [[agreement]] and tertiary clinic setting limits full endorsement. More prospective trials linking triage accuracy to patient‑centered [[outcome]]s are needed.

**Takeaway for neurosurgeons**:  
Chiropractors demonstrate acceptable diagnostic and strong management alignment with neurosurgeons. They may effectively triage non‑surgical [[low back pain]], helping reduce surgical wait times—but diagnostic nuance remains essential.

**Bottom line**:  
Chiropractor‑based triage shows promise for improving [[low back pain]] pathways, yet definitive benefit requires prospective [[validation]] with patient outcomes.

===== Citation =====  
 
**Publication date**: July 2, 2025  
**Corresponding author**: [[janny.mathieu@uqtr.ca]]