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When and how to refer?
Dear colleague, thank you for your trust when you refer a patient to our department. On this page you will find at a glance how to refer, what we would like to receive and which conditions you can refer to us for.
Our principle: first a correct diagnosis and honest advice, and only then, and only if necessary, surgery. A considerable proportion of referred patients are treated non-surgically by us or referred on in a targeted way within the multidisciplinary network (pain clinic, physical medicine, oncology).
How to refer?
Acute neurosurgical emergency: straight to the emergency department or 112. Suspected cauda equina syndrome (saddle hypoaesthesia, urinary retention or incontinence, bilateral deficit), acute plegia, new neurological deficit in a patient with known cancer (epidural compression), decreasing level of consciousness or signs of brain herniation. Do not lose time on imaging in primary care: the emergency physician reaches us via the internal on-call line.
For cases that cannot wait weeks, call or e-mail us directly as a physician: doctors' line 03 890 16 76, or info@drlavrysen.be with "verwijzing – semi-urgent" (referral – semi-urgent) in the subject line.
Typical examples: progressive paresis, rapidly increasing neurological deficit, suspected cervical myelopathy, a newly diagnosed intracranial space-occupying lesion, or a chronic subdural haematoma without decreased consciousness. We will then arrange a consultation at short notice or contact you ourselves.
Give your patient a referral letter and let them book an appointment themselves: online via drlavrysen.be/afspraak, or by phone on 03 890 16 74 (AZ Rivierenland) or 050 534 510 (AZ Zeno).
You receive a report after every consultation and every operation.
What to include in the referral letter?
A focused referral letter speeds up the pathway considerably. Useful information:
- Question: diagnosis, advice, second opinion or surgical assessment.
- Relevant medical history, including previous back or neck operations.
- Medication, in particular anticoagulants and antiplatelet agents. Do not stop these on your own initiative before the consultation; we will plan this with you if an operation follows.
- The conservative treatment so far: analgesia, physiotherapy, injections, and their effect.
- Available imaging, or where it was performed: we view images digitally via the hospital network.
Which imaging beforehand?
Imaging is not a requirement for referral. If the indication is unclear, we request the appropriate investigation ourselves. If something has already been done or you want to speed up the pathway, this is the most useful:
| Suspected condition | Useful beforehand |
|---|---|
| Radicular pain or claudication | MRI of the affected segment. In non-specific low back pain without red flags, imaging is not indicated. |
| Cervical myelopathy | MRI of the cervical spine. |
| Peripheral nerve entrapment | EMG (carpal tunnel, ulnar nerve, peroneal nerve). |
| Brain tumour | MRI of the brain with contrast; a CT is sufficient to start the referral. |
| Normal pressure hydrocephalus | CT or MRI of the brain. |
| Lump along the course of a nerve | Ultrasound or MRI. Do not have a suspected nerve tumour biopsied or excised before referral. |
What to refer and when?
Back and neck
Lumbar and cervical disc herniation, spinal stenosis, degenerative instability and spondylolisthesis, and revision surgery after previous back operations.
- Radicular pain without deficit: conservative treatment first (analgesia, relative rest with guided mobilisation, physiotherapy, possibly an injection). Refer if this has not helped sufficiently after six to eight weeks.
- Refer earlier in case of motor deficit or disabling, treatment-resistant pain.
- Cervical myelopathy (clumsy hands, gait disturbance, hyperreflexia): semi-urgent, even with mild symptoms.
Surgically, we work as minimally invasively as possible: endoscopic and microscopic lumbar discectomy, anterior cervical discectomy with cage or disc replacement, decompression for spinal stenosis, and lumbar fusion only when there is a clear, proven indication.
Neuro-oncology
Benign and malignant brain tumours and spinal tumours, including metastases. Every case is discussed at a multidisciplinary meeting (neurosurgery, oncology, radiotherapy, imaging, pathology). A newly diagnosed intracranial space-occupying lesion is best reported via the doctors' line, with the imaging; we will then quickly plan the further work-up.
Peripheral nerves
- Carpal tunnel syndrome: nocturnal paraesthesia in the thumb to ring finger with a confirmatory EMG is the classic referral. In case of thenar atrophy or motor deficit, preferably do not wait any longer. The release is performed as a day case.
- Ulnar nerve at the elbow: if symptoms persist after about three months of positional advice, and sooner in case of loss of strength or atrophy of the intrinsic hand muscles.
- Foot drop (peroneal nerve): EMG is most reliable from three weeks onwards. Refer if there is no recovery after six to twelve weeks, and sooner in case of pain or a palpable mass at the level of the fibular head. Foot drop with back pain and radiating pain may also be caused by an L5 radiculopathy.
- Meralgia paresthetica: can usually be treated in primary care. Refer in case of severe symptoms persisting after three months.
- Nerve tumours: a lump along the course of a nerve, often with a positive Tinel's sign. Semi-urgent in case of rapid growth, a diameter above 5 cm, pain at rest or new deficit, and certainly in NF1.
Hydrocephalus
Diagnosis and treatment of hydrocephalus in adults, with a shunt or endoscopic third ventriculostomy. In the older patient with the triad of gait apraxia, cognitive decline and urge incontinence, also consider normal pressure hydrocephalus, a potentially treatable cause of "dementia". The gait disturbance is usually the first and most obvious symptom.
Trauma and brain haemorrhage
Traumatic injuries of the skull, brain and spine are managed via the emergency departments of AZ Rivierenland and AZ Zeno. In the older patient, especially on anticoagulants, consider a chronic subdural haematoma, even if the fall seemed trivial or is not remembered: new headache, confusion, a gait disturbance or one-sided weakness justify a CT of the brain.
Consultations and addresses
| Campus | Consultation | Appointments |
|---|---|---|
| BornemAZ Rivierenland, Kasteelstraat 23 | Monday 10:00–18:00 and Thursday 9:00–17:00 | 03 890 16 74 |
| RumstAZ Rivierenland, 's Herenbaan 172 | Tuesday 13:00–18:00 | 03 890 16 74 |
| WillebroekAZ Rivierenland, Tisseltsesteenweg 27 | Tuesday 9:00–12:00 | 03 890 16 74 |
| Knokke-HeistAZ Zeno, Kalvekeetdijk 260 | Tuesday 10:00–18:00, every other week | 050 534 510 |
Or online via drlavrysen.be/afspraak.
About the department
Dr Eno Lavrysen is Head of Neurosurgery at AZ Rivierenland and neurosurgeon at AZ Zeno. He studied at the University of Antwerp and trained at UZA, UZ Gent and ZNA Middelheim, with additional expertise in minimally invasive spinal surgery, endoscopic spine surgery, neuro-oncological surgery and peripheral nerve surgery.
He is supported by a permanent team: Kelly De Munck, MSc (head nurse and coordinator, surgical scheduling and preoperative work-up), Julia Wrona (medical secretariat), Cinthia Remon and Mitch Kokke (surgical nurses).
Fee agreement status: Dr Lavrysen is not under the national fee agreement (non-conventionné). Patients entitled to increased reimbursement (verhoogde tegemoetkoming / intervention majorée) do not pay a fee supplement. Your patient can find more information on the contact page.
Frequently asked questions from referring physicians
Does there need to be an MRI before I refer?
No. Imaging is not a requirement; if the indication is unclear, we request the appropriate investigation ourselves. Existing images do speed up the pathway.
How quickly will my patient be seen?
Routine referrals follow the regular schedule. Semi-urgent cases (progressive deficit, myelopathy, new space-occupying lesion) are seen at short notice after a call to the doctors' line or an e-mail with "verwijzing – semi-urgent" in the subject line.
Will my patient be operated on in any case?
No. A considerable proportion of referred patients are treated non-surgically by us or referred on in a targeted way within the multidisciplinary network. Surgery only follows when there is a clear indication, in consultation with the patient and with you.
Can I discuss a case by phone first?
Yes, via the doctors' line 03 890 16 76. Collegial advice on imaging or further management is often possible without a consultation.
What about anticoagulants and antiplatelet agents?
Continue them until the consultation. If an operation or injection follows, we will plan the interruption with you and, where necessary, with the cardiologist.
Where can I find information to give to my patient?
Each condition has its own patient page with symptoms, treatment, risks and recovery: see drlavrysen.be/behandelingen. Practical information on costs, what to bring and cancellations is on /contact.