CHECKLIST FOR REFERRAL FOR LUMBAR SPINE SURGERY
For adult patients
Have you excluded a previous medical history of carcinoma?
Have you excluded reasons for emergency referral?2
Have you excluded simple mechanical back pain?3
For patients with nerve root pain, do they have matching
neurological signs and lesions on their MRI, and has their
condition failed to resolve within 6 weeks?4
Do you consider there is possible spinal claudication confirmed on
If the patient has co-morbidities, are they fit for surgery? Have the
risks of surgery been discussed with the patient?5
Is the patient prepared to attend for surgery within 3 months from
referral e.g. Are they in the country?6
Reason for referring if answering ‘No’ to any of above:-
Patients with PMH carcinoma with back pain and no neurological signs
should be referred back to their oncologist.
Patients with acute onset of bilateral leg pain below the knees, progressive
motor weakness, perineal numbness, bowel or bladder dysfunction, or who
have had recent surgery should be discussed with the on-call spinal surgeon
Most back pain resolves within 2 weeks, and 90% resolves within 3 months,
but recurrence is common – 73% within a year. Simple mechanical back pain
does not require specialist opinion. Patients with chronic pain should be
referred to Pain Clinic.
Patients with nerve root problems will have pain and/or paraesthesia with
matching neurological signs, and matching lesions on their MRI scan.
Features that might suggest spinal claudication are pain on walking which is
relieved by sitting
Spinal surgeons do not need to see patients unless they are candidates for
surgery and are fit and available for surgery to be performed.
References: Diagnosis and Treatment of Low Back Pain BMJ volume 332 17 June 2006