Appropriateness of Lumbar Spine Referrals to a Neurosurgical Service

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 13 I (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.