It is a grooming issue, not really a vet issue, though a vet could take care of it.
My Crystal is prone to this as well. The reason, with Crystal, is that she is pudgy and can't REACH the top middle of her back! Cats naturally secrete oils at each fur base. One reason they lick / groom is to spread out the oil. When they don't, these clumps develop. They are mats, and they pull at th skin so they do hurt and are quite uncomfortable for the cat. Crystal has had the area shaved twice in the past. (She is about 9 years old). After the second time, I was determined, I brush her regularly so I do not have this issue to spend money on again.
You do need to work out a plan. The area needs to be shaved out and going forward she needs regular grooming. Sounds like you have allowed her to set the rules.
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Without seeing what this looks like, it could be a number of things. Are the clumps of hair just sitting on her back like shedding and she simply can't reach or are they like spots from an irritation? Another thing I thought of is my mom's cat started pulling out her fur because she was stressed, could that be what's happening? Nothing has changed in the environment lately, has it? Sorry I can't be much help, but hope you can figure it out! If she's bright eyed and acting fine, I wouldn't worry too much about the vet unless it does look like some kind of skin condition.
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