Clin Orthop Surg.  2020 Mar;12(1):55-59. 10.4055/cios.2020.12.1.55.

Review of Physician Referrals to Orthopedic Spine versus Neurosurgery

• Malige A
• Yuh R
• Yellapu V
• Lands V
• Woods B
• Sokunbi G

• KMID: 2470051
• DOI: http://doi.org/10.4055/cios.2020.12.1.55

Abstract

BACKGROUND
Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.
METHODS
In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.
RESULTS
Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).
CONCLUSIONS
Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.

Keyword

Orthopedic; Neurosurgery; Spine; Primary care physician; Referra

MeSH Terms

Chronic Pain
Diskectomy
Education
Emergency Medicine
Hospitals, Community
Humans
Internal Medicine
Minimally Invasive Surgical Procedures
Neurology
Neurosurgeons
Neurosurgery*
Orthopedics*
Pain Management
Pathology
Physicians, Primary Care
Radiculopathy
Referral and Consultation*
Spine*
Surgeons

Figure

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  Fig. 1 Referral preference for radiculopathy in cervical spine, thoracic spine, and lumbar spine. OS: orthopaedic surgery, NS: neurosurgery.

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  Fig. 2 Referral preference for compression fractures, traumatic cervical fractures, traumatic thoracic fractures, traumatic lumbar fractures, and traumatic sacrum fractures. OS: orthopaedic surgery, NS: neurosurgery.

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  Fig. 3 Referral preference for chronic neck and back pain, sacroiliac joint pain, and scoliosis and kyphosis. OS: orthopaedic surgery, NS: neurosurgery.

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  Fig. 4 Referral preference by type of procedure physician believes is necessary. OS: orthopaedic surgery, NS: neurosurgery, Fusion: spinal fusion in any spinal location, Discectomy: discectomy in any spinal location, MIS: minimally invasive surgery.

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