Appropriateness of Elective Outpatient Spine Surgery Referral

Presented at SMISS Annual Forum 2018
By F. Sourial
With Samuel Overley , Steven McAnany , Todd Albert , Sheeraz Qureshi ,

Disclosures: F. Sourial None Samuel Overley None, Steven McAnany None, Todd Albert B; DePuy, a Johnson & Johnson Company, Nuvasive. D; ASIP, Biometrix, Breakaway Imaging, Crosstree, Facelink, Gentis, InVivo Therapeutics, Invuity, Paradigm Spine, PMIG, Spinicity, Vertech. F; Biomet, , Sheeraz Qureshi B; Zimmer-Biomet, Stryker Spine, Globus Medical Inc. D; Avaz Surgical. F; RTI, Zimmer-Biomet, Stryker Spine.,


Spine surgery wait times after referral from a primary care physician are amongst the highest of any specialty in the United States. Conversely, the surgical yield is disproportionately low due to inappropriate referrals made before a trial of conservative therapy and based off of nonspecific findings on CT or MRI.


Use of clinical triage scoring systems and determining patient factors leading to surgical intervention may help create a predictive algorithm improving wait times, clinical outcomes, and healthcare efficiency.


Data was collected retrospectively from 380 referred patients of three fellowship trained spine orthopedic surgeons during an eight-month period (May 2015- January 2016). A Pearson Correlation Coefficient was utilized to determine which patient factors positively and negatively predicted surgical referral.


Strong predictors of surgery included: Radicular pain (R 0.37), leg pain more than back pain (R 0.26), imaging prior to referral (R 0.27), seen by PM&R (R 0.26), and severe central canal stenosis on MRI (R 0.22). Strong negative predictors of surgery included: Duration of symptoms less than 6 weeks (R -0.24) and no arm or leg symptoms (R -0.26). Patients did not undergo conservative treatment (32%) or CT/MRI (18%) prior to referral. Only 32% of referrals were recommended spine surgery.


The majority of patients were deemed not appropriate surgical candidates confirming a need for an enhanced referral process. Education regarding patient factors predictive of surgery and incorporating an effective triage system could reduce wait times and improve clinical outcomes for appropriate surgical candidates that are often time sensitive.