The authors present their experience in a programme for second opinion evaluation of spine surgery candidates within a cohort of patients from a healthcare provider in Brazil. Ninety-four patients were evaluated, and the second opinion was divided in complete agreement, partial disagreement, and complete disagreement. Patients with complete disagreement were referred for a third medical opinion. A complete agreement was found in 22 cases, partial disagreement in 28 cases, and complete disagreement in 44 cases. The majority of the discrepancies between first and second opinion were found in lumbar degenerative disorders, with a reduction of 50% in the amount of surgical procedures and a 50% reduction in the rate of instrumentation within this subset of patients. Within 1 year of the index evaluation, only two patients who followed the proposed treatment guidelines were reoperated, giving an estimate of the adequacy of this second opinion programme.