The University of Pittsburgh Medical Center (UPMC) has adopted landmark guidelines for the management of chronic low back pain.
As of 2012, candidates for spinal surgery under the UPMC Health Plan must undergo a minimum of 3 months of conservative care, including chiropractic and health coaching before surgery is scheduled. This has been implemented in response to the high success rates of chiropractic intervention and the soaring rates of spine surgery.
Gerard Clum, DC, former president of the World Federation of Chiropractic and Life Chiropractic College West, and current executive committee member of the Foundation for Chiropractic Progress, stated, "The UPMC should be congratulated for its leadership is establishing policies to assure that the least invasive and most likely to be successful care strategies, including chiropractic care, are applied for a meaningful period of time before surgical considerations are made. This decision is both an important recognition of the value of chiropractic care in the acute low back pain environment as well as recognition of the clinical and economic downsides to spinal surgery in this situation."
SOURCE: UPMC Health Plan Policy and Procedure Manual, October 2011: Surgical Management of Low Back Pain
(partial list of considerations prior to spine surgery to determine medical necessity). Complete policy available at http://goo.gl/Rr7K8