Tool Kit for Spinal Surgery


National Low Back Pain Pathway and Regional Spinal Networks


Charles Greenough, National Clinical Director for Spinal Disorders


The report in 2013 of the Spinal Task Force demonstrated that spinal surgery in England is under pressure. In some areas there are no spinal services available, with patients having to travel to the next nearest spinal surgeon. Smaller hospitals face pressures in the provision of adequate audit and governance arrangements. Many spinal centres struggle to achieve compliance with the 18 week target. Some District General Hospitals have ceased to provide spinal surgical services.


Reviewing current practice

From a review of the service it was clear that that there were some issues with waiting list management, and large variation in surgical indications and rates between centres.


A toolkit for best practice

A downloadable toolkit has been produced which contains a number of best practice recommendations that can be implemented immediately to operate as a plan to reduce the number of waiting time breaches for spinal surgery and ensure the 18 week referral to treatment standard is met and maintained.


Next steps

Our Regional specialised commissioning teams will be working with the transformation team in each CCG commissioning collaborative to take this work forward. We are communicating with the Sustainability and Transformation Plan teams. We will also be inviting provider networks to take part in the peer review and design process on the future pathway of care.

If you are interested in being an early adopter of the Improving Spinal Care project email:




Document Downloads:


Toolkit for spinal surgery