Back Pain? Make Sure You and Your Spine Specialist are “Choosing Wisely”

North American Spine Society Releases List of Common Spine Tests and Treatments to Question

New Orleans, LA—During its 28th Annual Meeting, the North American Spine Society (NASS) today released a list of five specific tests and treatments that are commonly ordered but may not always be necessary in spine care. The list is part of Choosing Wisely®, an initiative of the ABIM Foundation, and identifies evidence-based recommendations that can support conversations between patients and physicians about the most appropriate care based on the patient’s individual circumstances.

“Because back pain is so prevalent and debilitating, desperate patients flock to their spine specialists’ offices armed with advice and anecdotes from well-meaning family, friends and online sources,” said F. Todd Wetzel, MD, NASS Choosing Wisely Task Force Chair and Professor and Vice Chair for the Department of Orthopedic Surgery and Sports Medicine and Professor of Neurosurgery at Temple University School of Medicine in Philadelphia. “We hope this list of recommendations will help spine care providers and their patients cut through the noise and make informed care decisions together.”

Five Things Physicians and Patients Should Question:

  1. Don’t recommend advanced imaging (e.g., MRI) of the spine within the first six weeks in patients with non-specific acute low back pain in the absence of red flags.
  2. Don’t perform elective spinal injections without imaging guidance, unless contraindicated.
  3. Don’t use bone morphogenetic protein (BMP) for routine anterior cervical spine fusion surgery.
  4. Don’t use electromyography (EMG) and nerve conduction studies (NCS) to determine the cause of axial lumbar, thoracic or cervical spine pain.
  5. Don’t recommend bed rest for more than 48 hours when treating low back pain.

To create this list, NASS appointed a multidisciplinary task force to identify five areas in which to make recommendations. Based on the scientific evidence, existing clinical practice recommendations and expert opinion, the task force collaboratively drafted a list of nine recommendations which was subsequently submitted to the NASS Board of Directors for review and ranking. After further refinement, the final list was approved by the NASS Board of Directors.

“The North American Spine Society has shown tremendous leadership by releasing its list of tests and procedures that may be commonly performed in spine care, but aren’t always necessary,” said Richard J. Baron, MD, President and CEO of the ABIM Foundation. “The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what evidence-based care they need, and what we can do to reduce waste and overuse in our health care system.”

To date, more than 50 national and state medical specialty societies, regional health collaboratives and consumer partners have joined the campaign to encourage conversations about appropriate care, including Consumer Reports, who is developing patient-friendly materials based on the society lists. With the release of these new lists, the campaign will have covered more than 250 tests and procedures that the specialty society partners say may be overused or unnecessary, and that physicians and patients should discuss.

About NASS: More than 3,000 spine professionals are meeting at the NASS 28th Annual Meeting in New Orleans, October 9-12, 2013 at the Ernest N. Morial Convention Center. The North American Spine Society is a multidisciplinary medical organization dedicated to fostering the highest quality, evidenced-based and ethical spine care by promoting education, research and advocacy. NASS is comprised of more than 8,000 members from several disciplines, including orthopedic surgery, neurosurgery, physiatry, neurology, radiology, anesthesiology, research and physical therapy. For more information, visit and find NASS on: NASS Facebook and NASS Twitter.