Madhu K. Singh, M.D., a board-certified physical medicine and rehabilitation (PM&R) physician, who specializes in non-operative spine care and rheumatologic conditions, is now with Midwest Orthopedics at Rush (MOR). Dr. Singh has expertise in acute and chronic pain, osteoarthritis of the spine and fibromyalgia. She is also certified in medical acupuncture.
Madhu K. Singh Joins Midwest Orthopedics at Rush

As stated in the March 31, 2016 news release, “Dr. Singh comes to MOR from Alexian Brothers Health System, Elk Grove Village, where she still serves as a PM&R physician. Her impressive credentials include Interventional Spine Fellowship training at Cleveland Clinic. She was chief resident at the University of North Carolina, Chapel Hill and received her medical degree from the University of Alabama in Birmingham.”
Dr. Singh told OTW, “Physicians whose focus is geared toward non-operative care will do their best to exhaust conservative measures before referring a patient to a surgeon. In some cases, however, surgical referral is indicated much sooner than that. In both instances, by evaluating and treating the patient first, we’re able to streamline a patient’s healthcare experience. We can then determine whether his/her case is most appropriate for surgery or conservative measures. This allows a surgeon to better concentrate on potential operative cases and creates an environment for the patient where their nonsurgical pain needs can be met.”
“Over the next few months we will be expanding our non-operative procedures to include acupuncture as well as interventional spine procedures.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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