Progression from outpatient referral to spinal surgery in an Australian cohort with degenerative spinal disease

Degenerative spine disease (DSD) encompasses a range of conditions with increasing prevalence and a significant burden of disease. Patients with DSD are often referred to a neurosurgery clinic with lengthy waiting times from referral to consultation. The reported proportion of referred patients who undergo spinal surgery varies from 20.05% to 54% in heterogenous study populations from predominantly North American and European study populations. These rates do not correlate with institutional data in the Australian public hospital system and there is limited Australian data in the literature. This retrospective study aimed to quantify the proportion of patients referred to a neurosurgery clinic who progressed to elective spinal surgery and explore predictors for surgery based on referral contents.

All patients referred for DSD to a single tertiary centre between 1/1/16 and 31/12/22 were included. Referrals for spinal pathology due to trauma, infection or tumour were excluded. Patient demographics, clinical presentation and imaging findings contained in the outpatient referral were recorded. Outcomes, including progression to surgery, were also recorded. Univariate and multivariate analysis was performed to determine predictive factors for surgery.

Of 5189 referrals, only 471 (9.1%) underwent surgery. Only 4.7% had surgery at our institution with the remaining 4.4% undergoing surgery elsewhere. Referrals from neurologists, rheumatologists and referrals specifying limb weakness or sensory change, were more likely to progress to surgery, although these predictors were only present in 0.7 - 3.9% of referrals. Axial pain negatively predicted surgery.

To our knowledge, this is the only study in an Australian population to analyse the outcome of DSD referrals to neurosurgery clinic, based on referral contents alone. The vast majority of patients do not require surgery. Though there are a few predictive factors, progression to surgery cannot reliably be predicted from the referral, highlighting the opportunity to improve patient outcomes and healthcare utilisation for patients with DSD.