Low back pain in neurosurgical outpatients: An audit

I read with interest an audit of a consecutive series of patients referred to a Neurosurgical Clinic with a diagnosis of low back pain: 91% of patients underwent an MRI and 22% proceeded to surgery mostly for lumbar stenosis. Back pain is a substantial clinical problem in public hospital outpatients in both Orthopaedics and Neurosurgery. The waiting time in our institution (Royal Adelaide Hospital) has been unacceptably long. In an effort to improve waiting time for assessment of low back pain initially the Orthopaedic Spinal Group proposed a physiotherapy-led clinic and subsequently the same model was adopted by the Neurosurgical Department. Patients are informed that a major part of the assessment will be undertaken by a Physiotherapist but that an Orthopaedic Spinal surgeon or a Neurosurgeon will be available at the Clinic. I see at least 70% of the patients attending the Clinics that I oversee. Concerns that serious pathology may be missed with the use of this model have not proven warranted. A computer-based template is used to generate a letter to the referring doctor at the time of the Clinic and it reaches him or her within two to three days. Patient acceptance of the model (based on satisfaction surveys) is high and I am aware of only one referral over the last six months where the General Practitioner objected to the mode of consultation. Of interest, the likelihood of an MRI being ordered from our Clinics, both Neurosurgical and Orthopaedic Spinal, is low (5%) and the percentage proceeding to surgery is equally low (3%). These low figures are at variance from those of Huang et al.,