Impact of Language Barriers on Medical and Surgical Management in Neurosurgery

Introduction: Language barriers often hinder patients from receiving transparent medical care. Despite the interpreter use, studies found unfavorable clinical outcomes among Limited English Proficiency (LEP) patients compared to English-speaking patients. Communication in neurosurgery is particularly challenging owing to complex diagnoses and surgical procedures. Nonetheless, research on LEP patients in neurosurgery is limited. This study assesses the effect of language barriers in medical and surgical management of back pain, a common chief complaint in neurosurgery.

Methods: Patients from 2018 to 2023 with a primary concern for back pain were identified at a single academic center and were divided into interpreter and non-interpreter groups. Patients requiring immediate surgery were excluded. Demographic, clinical (physical therapy [PT] referral and epidural steroid injections [ESI], and surgical information were collected through retrospective chart review. Descriptive analysis was performed using student’s t-test, Mann-Whitney U-test, and Pearson’s chi-squared tests as appropriate. Alpha was set to 0.05.

Results: 40 patients each were identified in the interpreter and non-interpreter groups. Patients in the interpreter group had lower rates of initial PT appointments (60% vs 80%, p = 0.012), lower mean and proportion of PT visits (3.11 vs 6.08, p = 0.004; 0.4 vs 0.58, p = 0.004), and were less likely to follow-up on ESI (37.5 % vs 62.5 %, p = 0.044). Fewer patients in the interpreter group underwent spine surgery (50.0% vs. 75.0%, p=0.036) but no difference was seen in surgical timing between the two groups (481.5 vs. 376.9 days, p=0.416).

Conclusion : The unfavorable outcomes of language barriers were also seen in neurosurgery. The effect extends beyond medical management to altering surgical rates among LEP patients. Further research is warranted on how hospitals and neurosurgeons can facilitate patients’ adherence to medical management and communication regarding surgical procedures.