Introduction: Low back pain is a leading cause of disability world-wide^(1,3). It is the most common reason for medical consultation in the United States^(2,3), yet the determination of specific causes for the majority of presentations remains elusive to most physicians.  No one single treatment approach has proven superior⁽³⁾ which offers the opportunity for the choices that physicians and their patients make to be arbitrary,  ineffective, or even detrimental to continued good health. The purpose of this study was to examine the impact of enhanced Mechanical Diagnosis in Therapy(MDT), a highly standardized assessment and care approach, on the rate of surgery for low back pain in a specific population.

Methods: This study is a retrospective claims analysis. The study used claims data from January 01 2019 to December 31 2020. Patients were included if they were diagnosed with low back pain before undergoing lumbar surgery. The patients were then categorized based on their involvement with an MDT based physical therapy program. Claims data from the date of an initial low back pain diagnosis through one year from the initial diagnosis were included in the analysis. If a surgical procedure took place before then end of the year the episode was considered complete. The number of patients that escalated to surgery were identified and group comparisons were made, after adjusting for demographic differences as well as comorbidity risk, duration of care, and frequency of visits. P-values for categorical variables were calculated using Chi-squared test. A p-value < .05 was considered significant.

Results: 1,678 patients were included in the analysis. There were 749 patients in the MDT intervention group with an average age of 44 years and 59% of the patients were male. There were 929 patients who were not part of the MDT intervention group with an average age of 43 and 51% were male. Nineteen patients (2.5%)  from the MDT group had lumbar surgery compared to seventy-seven patients (8.3%) in the non-MDT group.

Conclusion: The result of our analysis shows that an enhanced MDT intervention in patients diagnosed with lower back pain reduces the patient’s risk of escalating to surgery. Consistent with conservative care guidelines the results of this paper suggest that enhanced MDT based physical therapy reduces the rate of surgery in patients diagnosed with low back pain.