Do Spinal Surgeons ever diagnose Inflammatory Back Pain?

Sacroiliitis

By Dr Irwin Lim, Rheumatologist

The answer is of course YES. But, my suspicion is that it's rare.

In Sydney, many GPs refer chronic back pain patients to back surgeons. I would imagine that only some require surgery.

When I ask, many of the patients I diagnose with ankylosing spondylitis or spondyloarthritis, this holds true. When we rheumatologists eventually end up seeing the spectrum of patients who have lived with chronic spinal pain, many have had this experience.

Spinal surgery in Sydney is performed by neurosurgeons or by orthopaedic surgeons. In my experience, they are focussed usually on whether on not the patient needs a surgical procedure. If not, some may use guided steroid injections, some may start some form of analgesia, some may not add anything to the management. The patient then returns to GP care. Some end up in chronic pain clinics.

It's estimated that 5% of people living with chronic back pain have inflammatory back pain, spondyloarthritis.

The worldwide experience is roughly a delay of 10 years before a diagnosis is made. Most patients get to see a range of health professionals, including spine surgeons, prior to a diagnosis.

The persistent delay suggests that the diagnosis continues to be missed.

How should we educate fellow health professionals of this fact?

This seems a necessary step to start chipping away at this decade of a missing diagnosis.

I'd really be interested in your thoughts or experiences.