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Appropriateness of Lumbar Spine Referrals to a Neurosurgical Service

Published online by Cambridge University Press:  23 September 2016

J. Max Findlay  and
Nathan Deis
J. Max Findlay*
Affiliation:
Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Edmonton, Alberta, Canada
Nathan Deis
Affiliation:
Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Edmonton, Alberta, Canada
*
Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, 2D1.02 WMC, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
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Abstract

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Background:

Patients with lumbar spine complaints are often referred for surgical assessment. Only those with clinical and radiological evidence of nerve root compression are potential candidates for surgery and appropriate for surgical assessment. This study examines the appropriateness of lumbar spine referrals made to neurosurgeons in Edmonton, Alberta.

Methods:

Lumbar spine referrals to a group of ten neurosurgeons at the University of Alberta were reviewed over three two month intervals. Clinical criteria for “appropriateness” for surgical assessment were as follows: •“Appropriate” referrals were those that stated leg pain was the chief complaint, or those that described physical exam evidence of neurological deficit, and imaging reports (CT or MRI) were positive for nerve root compression. •“Uncertain” referrals were those that reported both back and leg pain without specifying which was greater, without mention of neurologic deficit, and when at least possible nerve root compression was reported on imaging. •“Inappropriate” referrals contained no mention of leg symptoms or signs of neurological deficit, and/or had no description of nerve root compression on imaging.

Results:

Of the 303 referrals collected, 80 (26%) were appropriate, 92 (30%) were uncertain and 131 (44%) were inappropriate for surgical assessment.

Conclusions:

Physicians seeking specialist consultations for patients with lumbar spine complaints need to be better informed of the criteria which indicate an appropriate referral for surgical treatment, namely clinical and radiological evidence of nerve root compression. Avoiding inappropriate referrals could reduce wait-times for both surgical consultation and lumbar spine surgery for those patients requiring it.

Résumé

RésuméContexte:

Les patients qui ont des symptômes à la colonne lombaire sont souvent dirigés vers une évaluation chirurgicale. Seulement ceux qui présentent des manifestations cliniques et radiologiques de compression d'une racine nerveuse sont des candidats potentiels à la chirurgie et à une évaluation en vue d'une chirurgie. Cette étude examine le bien fondé des orientations vers des neurochirurgiens à Edmonton, en Alberta, pour des problèmes lombaires.

Méthodologie:

Les demandes de consultation pour des patients adressés à un groupe de dix neurochirurgiens à l'Université de l'Alberta pour des problèmes lombaires ont été révisées au cours de trois périodes de deux mois. Les critères cliniques pour évaluer le bien fondé d'une évaluation chirurgicale étaient les suivants : la demande faisait état de douleurs aux membres inférieurs comme symptôme principal ou décrivait un déficit neurologique à l'examen physique et les rapports d'imagerie (CT ou IRM) montraient une compression d'une racine nerveuse. Ces demandes étaient considérés comme appropriés. Celles qui rapportaient des douleurs au dos et aux membres inférieurs sans spécifier quelle douleur était la plus intense, sans mentionner de déficit neurologique, et qui mentionnaient une compression possible d'une racine nerveuse dans le rapport d'imagerie étaient considérés comme incertaines. Celles qui ne mentionnaient pas de symptômes au niveau des membres inférieurs ou de signes de déficit neurologique et/ou ne contenaient pas de description de compression d'une racine nerveuse à l'imagerie étaient considérées comme inappropriées.

Résultats:

Quatre-vingt (26%) des 303 requêtes pour une évaluation chirurgicale étaient appropriées, 92 (30%) étaient incertaines et 131 (44%) étaient inappropriées .

Conclusions:

Les médecins qui dirigent des patients qui présentent des symptômes lombaires vers des spécialistes doivent être mieux informés des critères qui indiquent qu'un traitement chirurgical serait approprié, soit des observations cliniques et radiologiques de compression d'une racine nerveuse. Le fait d'éviter de diriger des patients pour lesquels une telle évaluation est inappropriée pourrait diminuer le temps d'attente tant pour la consultation en chirurgie que pour la chirurgie lombaire pour les patients chez qui elle est indiquée.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 6 , November 2010 , pp. 843 - 848
Copyright
Copyright © The Canadian Journal of Neurological 2010

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