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Spinal outpatient services in Central Adelaide

The Spinal Outpatient Clinics provide specialist services for patients with spinal disorders who are referred for assessment by a Medical Practitioner.

Clinics are located at 

They provide services to patients residing in the Local Health Networks (LHNs).

Referrals are also received from rural and remote areas of South Australia and some adjacent regions of NSW/VIC for whom SA services are most accessible.

Contact details 

Fax (for referrals): (08) 8222 2751 c/o Orthopaedic Spinal Unit

Appointment enquiries and new case appointments
Spinal unit: (08) 8222 5584

Review or change of appointments
Spinal outpatients: (08) 8222 5584

Appointment locations

Spinal outpatients: c/o Orthopaedic Spinal Unit

Location: Royal Adelaide Hospital
North Terrace, Adelaide SA 5000
Telephone: (08) 8222 5584
Fax: (08) 8222 2751

Services and clinics available

Spinal Outpatient Services comprise 2 clinic types:

  • Spinal Surgical Clinic (SSC): These clinics operating from the RAH/TQEH are staffed by Spinal Consultants and Spinal Fellows and are for the management of priority cases. Most commonly, this includes the assessment and follow-up of patients who are triaged as being urgent or semi-urgent candidates for surgical intervention.
  • Spinal Assessment Clinic (SAC): Patients identified as warranting non-urgent surgical consultation are seen in the SAC. The SAC currently operates from five sites in the Central and Northern Adelaide Local Health Networks and provides assessment and management services for patients with spinal disorders. Physiotherapists working in advanced practice roles consult in these clinics, with support provided from General Practitioners and Spinal Consultants as required.

Spinal outpatient appointments

The objective of a Spinal Outpatient Appointment is to provide an assessment of the patient, form a diagnostic opinion (which may require further imaging or investigation), and outline a management plan. 

Surgical intervention is recommended in a small percentage of cases and minor interventions (e.g. injection therapy) may be trialled where clinically indicated in the management of radicular problems. 

The majority of patients require education, guidance regarding appropriate conservative management approaches and transfer back to community-based care supported by a general practitioner. Most patient consultations span over one or two visits, followed by formal discharge. 

Potential surgical candidates may attend over a more extended time period with necessary follow-up post intervention.

Clinical conditions appropriate for assessment

Clinical conditions appropriate for assessment in Spinal Outpatient Clinics include

  • Spinal disorders with accompanying red flags identified
  • Radiculopathy (and symptoms severe enough to consider surgical intervention)
  • Spinal Claudication (with symptoms of sufficient duration and severity to consider surgical intervention)
  • Patients with non-specific low back pain who are considering surgical treatment.

Clinical conditions not appropriate for assessment

Clinical conditions not appropriate for assessment in Spinal Outpatient Clinics include:

  • Acute or sub-acute non-specific spinal pain 
  • Chronic non-specific spinal pain when surgical intervention is not a consideration
  • Radiculopathy or Spinal Claudication when symptoms are not severe enough to consider surgical intervention
  • Spinal pain with systemic inflammatory disorder suggested by symptoms or blood tests (refer to Rheumatology).

Cases of Acute Cauda Equina Syndrome or patients with severe/rapidly progressing neurological deficits should also not be referred to Spinal Outpatients. These patients require immediate assessment and should be referred to the Emergency Department or directly to the Spinal fellow/registrar on call at the Royal Adelaide Hospital on (08) 8222 4000.

Staff for Spinal Outpatient Clinics

Position title Name Contact number
Clinical director and head of unit Prof Brian Freeman (08) 8222 4466
Consultant staff Yun-Hom Yau
George Potter
David Hall
Mike Selby
(08) 8222 4466
Lead physiotherapist Matthew Beard (08) 8222 4466
Physiotherapy staff Emma Karran
Sooraj Venugopalan
Abi Ehrlich
Eamonn McCole
Ali Wigg
Scott Main
Andrew Chapman
Cameron Cramey
(08) 8222 4466
General practitioner Dick Lister (08) 8222 4466

Orthopaedic spinal outpatient services

Site location Staff attending Contact details
Spinal surgical clinic
Orthopaedic (spinal) outpatient department
Orthopaedic Spinal Consultants and Spinal Fellows Spinal unit
Tel: (08) 8222 2793
Fax: (08) 8222 2451
Spinal assessment clinic
Orthopaedic (spinal) outpatient department, RAH
Lead Physiotherapist and senior physiotherapist staff
The Queen Elizabeth Hospital General Practitioner Tel: (08) 8222 7010
Fax: (08) 8222 2751
GP Plus Health Care Centre Elizabeth Senior Physiotherapist Tel: (08) 7485 4000
Fax: (08) 8222 2751
GP Super-Clinic Modbury Senior Physiotherapist Tel: (08) 7425 8700
Fax: (08) 8222 2751
Port Adelaide Community Health Centre Senior Physiotherapist Tel: (08) 8240 9611
Fax: (08) 8222 2751

Clinical staff specialty areas

No specific specialty areas exist in the clinics described above.Adult patients referred for spinal assessment are triaged centrally and allocated appointments based on clinical urgency and residential address.

Adult patient with clinically significant scoliosis can be referred to Spinal Outpatients via the routine referral process. Children with scoliosis can be referred directly to the Women’s and Children’s Hospital scoliosis clinic.

Referral process

Preferred method of referral is by fax (08) 8222 2751. 

All referrals must be made via completion of a specific spinal outpatient referral template (PDF 40KB). Appointments will not be allocated until an appropriate referral is received.

Patient triage

All referrals to Spinal Outpatient Clinics are triaged by the Lead Physiotherapist to determine urgency prior to appointment allocation. 

A triage system identifies priority cases which are allocated an appointment in the Spinal Surgical Clinic. The remaining (non-urgent) cases are allocated to the Spinal Assessment Clinic at the RAH/TQEH or a regional location, based on residential address. The aim is to assess patients in clinically appropriate timeframes based on triage category. Non-urgent cases that do not require specialist assessment, may not be offered an appointment (based on referral information).

Immediate referral process

Where immediate (same day) consultation is required, the Orthopaedic Spinal Fellow or Registrar should be contacted via the RAH Switchboard: (08) 8222 4000. Alternatively, the patient can present to the Emergency Department.

Referral from Emergency Department to Spinal Outpatient Clinics

Emergency Department staff can directly refer patients to Spinal Outpatient Clinics only with prior approval from a Spinal Consultant or Spinal fellow/registrar. Access to Spinal Outpatient Clinics via this route is appropriate for patients who fit the urgent triage classification i.e. patients with spinal disorders who do not require immediate consultation but are considered to require assessment within a four week period (e.g. accompanying red flags identified). Non-urgent cases should be returned to the care of their General Practitioner.

Referral from Medical Practitioners within the RAH

Medical practitioners within the RAH can refer patients to Spinal Outpatient services as outlined in the Triage and Referral Guideline. In most cases (excepting immediate and urgent referrals) completion of the spinal outpatient referral template (PDF 40KB) is mandatory and must accompany an M60. 

Referral from Medical Practitioners from other hospitals

Medical practitioners from other hospitals can refer patients to Spinal Outpatient services as outlined in the Triage and Referral Guideline

In most cases (excepting immediate and urgent referrals) completion of the spinal outpatient referral template (PDF 40KB) is mandatory.

Eligibility

Patients over the age of 18 years whose main residence is within South Australia. Referrals may also be received from specific adjacent regions of NSW/VIC for whom SA services are most accessible.

Ineligible patients

Ineligible patients include all overseas students and visitors from countries who do not have a Reciprocal Health Care Agreement with Australia. Ineligible patients may be charged for public hospital services. 

Compensable patients e.g. Workcover are also not eligible to access this publicly funded service as compensation covers the cost of private medical expenses.

Immediate priority Spinal examples
(not an exhaustive list)
Condition requires immediate surgical consultation.
  • Acute Cauda Equina Syndrome
  • Severe/rapidly progressing neurological deficits.
Referral process: refer immediately to the Emergency Department or contact the Spinal Fellow or Neurosurgery Registrar at the RAH: (08) 8222 4000.
Urgent priority Spinal examples
(not an exhaustive list)
Condition has a high probability of requiring surgical care and there is likely to be a significant adverse impact on outcomes and quality of life if surgery or assessment is delayed.
  • Spinal Disorder with accompanying red flags identified (e.g. tumour, infection)
Referral process: refer to the Spinal Outpatient Department via completion of referral template. Fax: (08) 8222 2751 and clearly mark referral as urgent.
In addition, cases can be discussed with the Spinal Fellow via RAH switchboard on (08) 8222 4000.
Semi urgent priority Spinal examples
(not an exhaustive list)
Condition has the potential to have some impact on surgical outcome if assessment is delayed.
  • Radiculopathy, not improving after 4-6 weeks and surgery is being considered.
  • Spinal Claudication with symptoms of sufficient duration and severity for patient to consider surgery.
Referral process: refer to the Spinal Outpatient Department via completion of referral template. Fax: (08) 8222 2751. Alternatively, referral can be made to the Neurosurgery Department. Fax: (08) 8222 2171.
Condition has the potential to have some impact on surgical outcome if assessment is delayed.
  • Spinal Disorder with systemic inflammatory features suggested by CBE, ESR and/or C-reactive protein.
Referral process: refer to the Rheumatology Outpatient Department. Fax referral to: (08) 8222 5895.
Non-urgent priority Spinal examples
(not an exhaustive list)
Condition is unlikely to deteriorate quickly or require more complex care if assessment is delayed.
  • Patients with non-specific low back pain who are considering surgical treatment.
  • Significant deformity/scoliosis.

 

Referral process: refer to the Spinal Outpatient Department via referral template. Fax: (08) 8222 2751. Consider options for community-based management as appropriate.
Specialist Consultation rarely required  
Condition is unlikely to benefit from surgical intervention.

Patients with non-specific spinal pain including:

  • strain/sprain
  • spondylosis, discogenic pain
  • facet joint arthropathy
  • osteoporotic compression fractures
  • spondylolysis spondylolisthesis.
Referral process: consider further options for community-based management.

Expected waiting times for Spinal Consultation depending on clinical urgency

Urgency category Maximum wait time
Immediate Immediate admission to ward or Emergency Department
Urgent Patient to be allocated a Spinal Surgical Clinic appointment within 4 weeks
Semi urgent Likely to be seen within 12 weeks* in the Spinal Surgical Clinic.
Non urgent Likely to be seen within 12 months* in the Spinal Assessment Clinic.

* Estimated maximum waiting time for an outpatient appointment. Waiting times are dependent on fluctuations in service demands and clinical capacity.

Spinal clinical information sheets

The following information sheets about presentations commonly seen in spinal outpatients provide the minimum information required for assessing a referral under the headings of: 

  • eligibility
  • priority
  • differential diagnosis
  • clinical information and investigations required
  • pre-referral management strategies
  • discharge criteria.

Spinal information sheets

 

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