Referring doctors

A responsive neurosurgical referral partner for brain and spine care
When your patient needs neurosurgical evaluation, our goal is to make the referral process clear, efficient, and clinically useful.

We have tried to make this site helpful to patients and referring doctors for understanding neurosurgical care. For more information on how we think about neurosurgery, review the BRAIN CARE and SPINE CARE sections. At the bottom of each section, we added a quick summary specifically for referring doctors.

We work closely with primary care physicians, urgent cares, pain specialists, neurologists, orthopedists, therapists, emergency physicians, and other specialists to help patients receive timely, thoughtful care.

How to send referrals

Non-Mercy physicians: Call (314-270-9494) or fax (314-270-9495).

Mercy physicians: Place an order in Epic. Type “Neurosurgery Peter Sylvester” and select *Peter Sylvester.

If referral is urgent / emergent: Please call / text me or call our office to discuss your concerns with our staff, a provider will call you back to discuss ASAP

Contact us

When to refer a patient

Any patient with YOU think would benefit from a discussion with a neurosurgical specialist!

If you are unsure if your patient was a diagnose we treat, you have a few options:

  • Use this site:
    • Review the list below
    • Click here for comprehensive list of the general conditions and procedures performed in our practice.
  • Just send them:
    • We review all referrals.
    • We treat most neurosurgical problems.
    • If it we do not offer the needed treatment, we can provide a referral to someone in the community who does
  • Call / text me:
    • If you do not have my number already, call the clinic at 314-270-9494.
    • Ask for my medical assistant, they will let you know how to contact me directly.

Referral urgency

Non-urgent referrals

Patients are seen in 2-4 weeks.

Spine conditions

  • Moderate cervical, thoracic, or lumbar radiculopathy
  • Spinal stenosis
  • Herniated discs with moderate to severe pain, without weakness
  • Spondylolisthesis
  • Mild to moderate chronic myelopathy
  • Compression fractures
  • Failed prior spine surgery

For the above conditions, most patients will have to have failed a course of conservative therapy such as physical therapy prior to surgical discussion. We are happy to see the patient before or after conservative care is complete.

Brain and cranial conditions

  • Benign brain tumors without neurologic deficit
  • Unruptured cerebral aneurysms
  • Unruptured vascular malformations
  • Normal pressure hydrocephalus
  • Chiari malformation
  • Cranial nerve compression (like trigeminal neuralgia)
  • Follow-up for:
    • Subarachnoid hemorrhage
    • Intracranial hemorrhage
Urgent referrals

We save space in our clinic to see all urgent referrals in 48-72 hours, which can include:

  • Severe low back or radiating pain
  • Acute, but stable fracture type (or office will help you determine stability)
  • New brain tumor without neurologic deficit
  • Signs of progressive or severe myelopathy (general weakness, spasticity, gait instability, hyperreflexia, “T2 signal change” in spinal cord on MRI)
Emergent referrals

Please contact our office immediately and send to the closest emergency room

  • Rapidly progressive weakness
  • Cauda equina symptoms (severe lumbar symptoms with saddle anesthesia / urinary retention)
  • Concern for infection, tumor, unstable fracture, or hemorrhage
  • Concern for ruptured aneurysm (severe sudden headache, neuro changes)
  • Concern for acute hydrocephalus (severe headache, sleepiness, blurry vision, neuro changes)
  • Acute intracranial bleeding

Barriers to referral

Minimal. We evaluate patients regardless of:

  • Comorbidity
  • BMI
  • Nicotine use
  • Insurance type
  • Prior surgical history
  • Complexity
  • Prior imaging

Potential barriers to referral:

  • We cannot see patients as a second opinion IF the first opinion was given by an STL MISC or Mercy Hospital South surgeon. We worry this may limit objectivity.
  • In some cases, we may redirect care to another specialty or provider after imaging / history review, if we feel there is a more appropriate next step in care.
  • If clinic wait times become extended, we may recommend evaluation by a partner physician.

What helps us evaluate patients efficiently

For the most complete evaluation, please send:

  • Recent office notes
  • Relevant imaging reports
  • MRI, CT, or X-ray images when available
  • EMG/NCS results, if completed
  • Prior operative reports
  • Medication list
  • Physical therapy or injection history
  • Insurance authorization information, if required