Background/Purpose: Surgical treatment of spinal pain is rarely indicated. Nevertheless, primary care clinician referrals to spinal surgeons for evaluation of spinal pain conditions are common. In the publicly funded hospital system in Australia, more than 90% of those referred to spinal surgeons with back pain do not receive surgery. It may be more appropriate for many people with spinal pain to be diagnosed and managed under a different model of health care.

Methods: A weekly spinal pain clinic was established at a publicly funded hospital. The clinic was staffed by a rheumatologist and 4 physiotherapists. All spinal pain referrals to the hospital’s spinal surgeons were diverted to the new clinic, with the exception of referrals assessed as likely spinal cord compression or cauda equina syndrome. Patients with previously diagnosed chronic spinal pain were not seen in the new clinic. Clinical and administrative data was prospectively and routinely collected including clinical diagnosis, Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire, and clinical outcomes including whether spinal surgery was done. An 11-point Likert scale (0-10) was used to collect the patient satisfaction with the clinic following the encounter.

Results: A total of 575 face-to-face patient encounters occurred in the first 12 months of the service including 363 new patients. Low back pain with radiculopathy was the commonest diagnosis. Average Örebro score was 67%. The failure-to-attend rate was 7%. Nearly half of the patients were discharged to community physiotherapy management, 2% to a chronic pain service, and 9%to a spinal surgeon. For patients referred to a spinal surgeon, 80% underwent spinal surgery. Average patient satisfaction was 9.2.

Conclusion: A novel model of care involving the substitution of spinal surgeons with a rheumatologist and physiotherapists for the assessment of patients with spinal pain was established. The patients assessed had a high estimated risk for future work disability. Efficient clinical care and a high patient satisfaction was demonstrated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-a-diversionary-back-pain-service/