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Multidisciplinary Evaluation Improves the Value of Lumbar Spine Care

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Value-Based Approaches to Spine Care

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Abstract

Rates of lumbar spine surgery in the United States have increased eightfold over the last three decades. While lumbar spine surgery has been shown to be effective in some randomized controlled trial settings, other nationwide analyses show overall outcomes no better than nonoperative care. There are many variables that influence the choice of therapy for spinal disease, and patient variables have powerful effects on outcomes; multidisciplinary decision-making improves outcomes in many domains.

The lack of integrated systems for comprehensive care for spinal disorders has contributed to the overutilization of spine surgery in the United States. However, increasingly, centers around the country are embracing multidisciplinary, team-based care to provide a wider range of options for patients. Multidisciplinary decision-making and access to multimodal treatment ultimately offers patients better outcomes, lower costs, and greater satisfaction.

Virginia Mason Medical Center in Seattle has offered a multidisciplinary review conference for team-based decision-making since 2015. Collaborative review of spine cases by a team of surgeons, physiatrists, and pain specialists was associated with a 58% reduction in immediate surgical interventions in patients who had been recommended a spinal fusion by an outside spine surgeon.

Montefiore Medical Center in New York City has established a true multidisciplinary clinic – having a spine surgeon (neurosurgery or orthopedics), physiatrist, and interventionalist present simultaneously while seeing patients, and ultimately introducing patients to each provider specialty, as appropriate, so that patients can efficiently get the right care.

Multidisciplinary processes like these can significantly influence the care of patients with degenerative spinal disorders, resulting in more appropriate use of surgical interventions and better candidate selection while providing patients with more diverse nonoperative treatment options. While long-term patient outcomes remain to be determined, such multidisciplinary care will likely be essential to improving the quality and value of spine care in the United States.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine, The Bronx, NY, USA

    Vijay Yanamadala & Reza Yassari

  2. Center for Surgical Optimization, Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, The Bronx, NY, USA

    Vijay Yanamadala

  3. Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA

    Anna K. Wright & Andrew S. Friedman

  4. Department of Physical Medicine and Rehabilitation, Virginia Mason Medical Center, Seattle, WA, USA

    Andrew S. Friedman

  5. Division of Interventional Spine, Department of Rehabilitation Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA

    Andrew I. Gitkind

  6. Center for Healthcare Solutions, Department of Medicine, Virginia Mason Hospital and Seattle Medical Center, Seattle, WA, USA

    Robert S. Mecklenburg

  7. Neuroscience Institute, Departments of Neurosurgery Health Services, Virginia Mason Medical Center, Seattle, WA, USA

    Rajiv K. Sethi

Authors
  1. Vijay Yanamadala
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  2. Anna K. Wright
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  3. Andrew S. Friedman
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  4. Reza Yassari
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  5. Andrew I. Gitkind
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  6. Robert S. Mecklenburg
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  7. Rajiv K. Sethi
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Corresponding author

Correspondence to Anna K. Wright .

Editor information

Editors and Affiliations

  1. Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA

    Rajiv K. Sethi

  2. Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA

    Anna K. Wright

  3. Columbia University, New York, NY, USA

    Michael G. Vitale

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Yanamadala, V. et al. (2020). Multidisciplinary Evaluation Improves the Value of Lumbar Spine Care. In: Sethi, R., Wright, A., Vitale, M. (eds) Value-Based Approaches to Spine Care . Springer, Cham. https://doi.org/10.1007/978-3-030-31946-5_4

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  • DOI: https://doi.org/10.1007/978-3-030-31946-5_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-31945-8

  • Online ISBN: 978-3-030-31946-5

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