Potential triaging of referrals for lumbar spinal surgery consultation: a comparison of referral accuracy from pain specialists, findings from advanced imaging and a 3-item questionnaire

• Published in: Canadian journal of surgery 2009, Vol.52 (6), p.473-480
• Main Authors: Simon, David, MD, Coyle, Matt, BSc, Dagenais, Simon, DC PhD, O’Neil, Joseph, MD, Wai, Eugene K., MD, MSc
• Format: Article
• Language: fre
• Subjects: Surgery
• ISSN: 0008-428X
• DOI: 10.1016/S0008-428X(09)50186-5

Background: Waiting times to see a spinal surgeon are among the highest in Canada. However, most patients who are referred would not benefit from surgical care. Effective triaging of surgical candidates may reduce morbidity related to prolonged waiting times and optimize use of limited resources. Methods: We administered a questionnaire consisting of 3 items identifying legdominant or back-dominant pain among 119 consecutive patients who presented at a community spinal pain centre or a spinal surgical unit for assessment of an elective lumbar problem. We analyzed the questionnaire under 2 different scenarios: 1 hypothesized to be more sensitive and 1 hypothesized to be more specific. Results: For the “sensitive” scenario of clearly back-dominant pain, the sensitivity of the questionnaire was 100% in identifying appropriate surgical candidates. For the “specific” scenario of leg-dominant pain, the questionnaire had a sensitivity of 83% and specificity of 73% in identifying appropriate surgical candidates, which was significantly superior to findings on computed tomography or magnetic resonance imaging (i.e., presence of neurocompressive lesions). When comparing the accuracy of the questionnaire in identifying appropriate surgical candidates to that of an assessment performed by a pain specialist at an acute spinal pain clinic, we found no statistically significant differences between the 2 methods. Conclusion: Use of the questionnaire when triaging patients may decrease the number of unnecessary referrals to spine surgeons. Adopting such a method of triaging could reduce waiting times for appropriate surgical candidates and potentially improve the outcomes of any resulting spinal surgery performed in a timely fashion. Contexte : Les temps d’attente pour consulter un chirurgien de la colonne sont parmi les plus longs au Canada. La plupart des patients référés ne bénéficieraient toutefois pas de soins chirurgicaux. Un triage efficace des candidats à l’intervention chirurgicale pourrait réduire la morbidité reliée aux attentes prolongées et optimiser l’utilisation de ressources limitées. Méthodes : Nous avons administré un questionnaire à 3 items pour identifier la douleur dominante dans la jambe ou dans le dos chez 119 patients consécutifs qui se sont présentés à un centre communautaire de traitement de la douleur de la colonne ou à une unité de chirurgie de la colonne pour évaluation d’un problème lombaire électif. Nous avons analysé le questionnaire suivant