Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: R. Rampersaud


M. Canizares(1), R. Rampersaud(1), E. Badley(2)

(1) Krembil Research Institute, University Health Network, The Arthritis Program, Toronto, ON, Canada
(2) Krembil Research Institute, University Health Network, Arthritis Community Research and Evaluation Unit, Toronto, ON, Canada


Background: Back disorders are one of the most prevalent and costly health problems, where the majority of patients recover, but a minority have long term problems. However to identity patterns in the course of back pain requires follow up of over a long period of time. Using a population-based sample we looked at the course of back disorders over 16 years to identify distinct trajectory groups. We also compared indicators of medication and healthcare use by these trajectory groups.

Methods: A cohort of 12845 individuals from the study of a representative sample of the Canadian population was followed-up from 1994 to 2011. Cohort participants were interviewed bi-annually and provided data on socio-demographic (e.g. sex, education, income), lifestyles (e.g. physical activity), pain, disability and comorbidities. They also provided information on medication use (e.g. opioids) and healthcare use (primary care, specialists (e.g. surgeons), physiotherapy, chiropractic and massage therapy). We used latent group-based analysis to group participants based on the patterns of the course of back disorders over the 16-year follow-up. We then compared indicators of pain, disability, medication and healthcare use by the groups.

Results: Overall, 45.7% of participants reported back disorders at least once during follow-up. They were allocated into four distinct trajectories of back disorders: persistent (18.3%), developing (32.6%), recovery (25.0%), and occasional (24.1%). Those with higher education and/or income were more likely to experience a trajectory of recovery, while these factors were not significantly associated with the developing and persistent groups. The persistent and developing groups were characterized by having pain preventing activities, more disability, and more comorbidities. There were significant differences in the patterns of medication and healthcare use across the groups. There was a general trend in healthcare use across all services from most to least in the persistent, developing, recovering, and in the occasional groups. For example, 35.0% of those with persistent back disorders consulted with specialists (most likely surgeons) compared to 26.0%, 27.1%, and 20.0% of those in the developing, recovering, and occasional groups. There were also significant differences in the use of opioids (persistent: 10.1%, developing: 6.4%, recovering: 5.2%, occasional: 2.9%), pain killers, tranquilizers and anti-depressants. Generally, the patterns of healthcare use over time mirrored the back disorders trajectory.

Conclusion: The findings support the notion that almost one-in-five people with back disorders are likely to experience a persistent trajectory and thus account for significant portion of the socioeconomic burden of back disorders. Further research is needed to determine whether these groups represent different diagnoses, which may provide insights to the selection of stratified treatments. Consideration of these trajectories also offers the potential to better manage back disorders and may aid designing early prevention and management strategies in the population.