Changes in referral pattern to a surgeon for low back pain: 1996 versus 2009

The high prevalence of low back problems and increasing demand for surgery necessitate an efficient use of resources. The current study repeated a 1996 study to determine any changes in referral patterns. A seven-week prospective study included patients referred for back pain to spine surgeons in one centre. Demographic data, referral letters, wait times, investigations prior to the visit and visit outcomes were collected. Of 160 patients, 5% were excluded from the study due to incomplete data. The mean age was 53 years, 53% were female and 11% had ongoing workers' compensation cases. Compared with 1996, family physicians continue to refer the majority of patients and the average wait time increased from 10 to 13 weeks currently. The proportions of patients with pain in the leg or back were similar to 1996. The most common investigation ordered prior to the visit was magnetic resonance imaging (MRI, 73%), then computed tomography (CT, 41%) and radiography (39%), whereas in 1996, radiography was the most common (68%), then CT (37%) and MRI (11%). However, the number of surgical candidates remained relatively stable, at 19% in 1996 and 16% currently. The most common visit outcome was a diagnosis of chronic pain not amenable to surgery (34%), which had increased from 25% in 1996. Imaging is not an effective method of screening for surgical candidates as the decision to offer surgery is based more on the clinical picture. More resources should be dedicated to chronic pain management and improved screening to redirect the increased number of non-surgical patients with chronic pain.