Document Type : RESEARCH PAPER
Authors
1
Department of Special Surgery, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
2
Hospital for Special Surgery, New York, USA
3
Hamad Medical Corporation, Doha, Qatar
4
Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
5
College of Medicine, Hebron University, Hebron, West Bank, Palestine
6
Misr University for Science & Technology, Giza, Egypt
7
Dar AlUloom University, Riyadh, Saudi Arabia
8
Cairo University, Cairo, Egypt
9
College of Medicine, University of Baghdad, Baghdad, Iraq
10
Faculty of Medicine, University of Jordan, Amman, Jordan
11
University of Tennessee Health Science Center, Tennessee, USA
10.22038/abjs.2026.93833.4235
Abstract
Objectives: This study aimed to examine physician referral preferences between neurosurgeons and orthopedic spine surgeons across the Middle East and to identify factors influencing these decisions.
Methods: A multinational, cross-sectional, web-based survey was distributed between September 2023 and June 2025 to actively practicing physicians in the Middle East. The survey instrument captured demographic characteristics, access to dedicated spine centers, perceptions regarding specialty-specific training, and referral preferences for a range of spinal pathologies. Statistical analyses were performed using chi-square tests and Fisher’s exact tests, as appropriate.
Results: A total of 861 valid responses were analyzed. Overall, 52% of physicians preferred referring patients to neurosurgeons for long-term spinal care. Referral preferences varied significantly by condition: radiculopathy and spinal tumors were predominantly referred to neurosurgeons (P < 0.001), while spinal fractures, deformities, and fusion/disc replacement procedures were referred to orthopedic surgeons (P < 0.001). Access to a comprehensive spine institute significantly influenced referral patterns, with balanced preferences observed among physicians with access and a neurosurgical bias among those without (P = 0.019).
Conclusion: In this large regional survey, referral decisions for spine care in the Middle East were shaped by specialty perceptions, access to multidisciplinary centers, and clinical context. Despite varying opinions on training equivalence, neurosurgeons and orthopedic surgeons were both recognized as capable providers for spine patients. Expanding integrated spine care models may help reduce referral bias and promote condition-specific, patient-centered referral decisions.
Keywords
Main Subjects
)