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One Quarter of Spinal Decompression Surgeries Occurring Without Receiving Physio

Low back pain ranks as the world’s leading cause of years lived with disability, resulting in a high economic burden.

Low back pain ranks as the world’s leading cause of years lived with disability, resulting in a high economic burden.(1) Most cases of non-specific low back pain can be treated conservatively. In fact, clinical practice guidelines call for conservative rehabilitation before back surgery.(2,3) The question is, “Do patients receive conservative rehabilitation or enough rehabilitation before moving on to back surgery?” In New South Wales, for half of patients, the answer may be “no.”

Workers’ compensation records show that in New South Wales, before spinal decompression surgery, more than a quarter of patients receive no physiotherapy. Nearly another quarter of patients receive only one to eight physiotherapy sessions before decompression surgery. These were some of the top observations made by Joshua Zadro, University of Sydney, and his research colleagues. BioMed Central scheduled their first-of-its-kind study for publication in December and released it early electronically.(4)

Zadro et al. acknowledge that they structured their study only to report utilization patterns before surgeries. From this data, one cannot glean what percentage of patients receiving few physiotherapy visits were assessed as not suitable for exercise therapy and referred to surgery appropriately. Nevertheless, Zadro and colleagues find it likely that there is opportunity to achieve more cost-effective and less invasive healthcare in NSW.

Lumbar spine surgeries in Australia cost roughly $53,000. Compare that to the cost of physiotherapy before decompression surgery at only $1,265.(5) Broader and earlier utilization of physiotherapy may be one strategy that can improve patient outcomes and reduce costs in NSW’s workers’ compensation system.



  1. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018 Nov 10;392(10159):1789-858.
  2. National Institute for Health and Care Excellence (NICE) Guidelines. Low back pain and sciatica in over 16s: assessment and management. November 2016.
  3. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CW, Chenot JF, van Tulder M, Koes BW. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal. 2018 Nov;27(11):2791-803.
  4. Zadro JR, Lewin AM, Kharel P, Naylor J, Maher CG, Harris IA. Physiotherapy utilisation and costs before lumbar spine surgery: a retrospective analysis of workers compensation claims in Australia. BMC Musculoskeletal Disorders. 2021 Dec;22(1):1-0.

Australian Commission on Safety and Quality in Health Care. Prioritised List of Clinical Domains for Clinical Quality Registry Development. Final Report

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