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Lumbar spine procedures for simple lumbar back pain

This is a summary of the NHS Devon commissioning policy for Lumbar Spine Procedures – for simple lumbar back pain

This guidance is intended for simple lumbar back pain. It does not cover suspected malignancy, or nerve root compression

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History and Examination

Patient presents with acute lumbar back pain:

  • Full history is taken to exclude any comorbidities

Conservative treatment consisting of:

  • Muscle relaxants
  • Analgesics
  • Education regarding lifestyle including where appropriate, weight loss, physical activity

If pain continues:

  • consider injection therapy including steroid and epidural injections where appropriate
  • refer to physio if appropriate for posture assessment / training

If patient has not resumed usual activity levels after 3 months refer to specialist service which could include:

  • back pain physio specialist
  • psychological input
  • pain management team

If patient has not resumed usual activity levels after multi-disciplinary treatment consider referral to specialist

Referral Criteria

Surgery for lumbar back pain should only be considered after the full range of primary care interventions has been used.

Referral for consideration of surgery should only occur if the patient fulfils the following criteria:

  • Has received conservative treatment including:
  • Muscle relaxants
  • Analgesics
  • Posture assessment / training
  • Education re lifestyle including where appropriate, weight loss, physical activity
  • Injection therapy including steroid and epidural injections where appropriate
  • Referral to a multi-disciplinary back-care team
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