Spinal outpatient services in Central Adelaide

Changes to the Orthopaedic Spinal Service

To improve access to spinal services for appropriately triaged patients and furthermore enhance the management of spinal disorders in primary care, changes have been implemented as outlined below:

  • Cases of Acute Cauda Equina Syndrome or patients with severe/rapidly progressing neurological deficits should NOT be referred to outpatients clinics.
  • These patients should be referred directly to the Royal Adelaide Hospital (RAH) Emergency Department or call the RAH switchboard on (08)7074 0000 and ask for the spinal fellow/registrar on-call to discuss the patient.

Outpatient information

The Spinal Outpatients Clinic provides specialist services for patients with certain spinal disorders (including trauma and tumours) who are referred for assessment by a medical practitioner. The Spinal Clinics offer services to all patients residing across the metropolitan/country local health networks (LHNs) and some adjacent regions of the Northern Territory, New South Wales and Victoria for whom SA services are more accessible.

Clinics are located at:

Contact details

Referrals should be faxed to (08) 7074 6247

All referrals should be made with a standard referral and should be sent with a competed spinal outpatient referral template (RTF 2MB) 

Appointments will not be allocated until an appropriate referral is received

For further information / appointment queries, contact the Outpatient Call Centre on 1300 153 853

Patient triage

All referrals to spinal outpatient clinics are quickly assessed to determine urgency prior to appointment allocation. The aim is to assess patients in clinically appropriate time frames based on triage category.

  • A triage system identifies priority cases which are usually allocated an appointment in the Spinal Surgical Clinic.
  • Some of the remaining non-urgent cases are allocated to the Spinal Assessment Clinic at the RAH/TQEH or an outreach site.

Please note, non-urgent cases that do not require specialist assessment may not be offered an appointment (based on referral information).

Referrals from Emergency Department to spinal outpatients

  • Emergency Department (ED) staff can directly refer patients to spinal outpatient clinics only with prior approval from a spinal consultant/fellow/registrar.
  • Access to spinal outpatient clinics via this route is appropriate for patients who fit the urgent triage classification, such as patients with spinal disorders who do not require immediate consultation but are considered to require assessment within a four-week period (accompanying clinical red flags identified).

All non-urgent cases should be returned to the care of their general practitioner.

Our services/procedures

Spinal outpatient services comprise of the following services:

Spinal Surgical Clinic (SSC)

This clinic operates from the RAH and is staffed by spinal consultants/fellows and registrars is for the management of priority cases. Most commonly, this includes the assessment of patients who are triaged as being urgent or semi-urgent candidates for probable surgical intervention.

Spinal Assessment Clinic (SAC)

Patients identified as warranting non-urgent consultation are allocated to the SAC. The service currently operates from 3 sites within the Central Adelaide Local Health Network (CALHN) and also delivers a suite of Telehealth services for both metro and country patients. The SAC provides assessment and surgical triage for patients with certain spinal disorders. These clinics are staffed by physiotherapists who work in an advanced practice role, with support provided by spinal surgeons as required.

Spinal Virtual Clinics

For referrals that are not accepted following careful clinical triage, then management advice and review is offered via a Virtual Clinic. This will involve referrals who are triaged as unlikely to require surgery or those simple spinal fracture cases that can be safely managed remotely.
This process involves:

  • review the GP referral and relevant radiology reports
  • an assessment in the context of patient’s reported signs and symptoms, history and relevant imaging
  • provision of customised clinical advice via a letter to the referring GP that may include conservative management options or appropriate surveillance imaging.

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 (such as injection therapy) may be trialled where clinically indicated in the management of radicular or claudicant problems.

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

Surgical candidates may attend over a more extended period of time with necessary follow-up post spinal intervention.

Orthopaedic Spinal Services at RAH

General Practitioners referring their patients to Orthopaedic Spinal Services must complete the referral form below:

It is mandatory that the form is completed and faxed or posted to RAH Spinal Outpatient Services (see the form for details). Failure to do so will result in the referral being returned for completion prior to processing and triage.

Clinical conditions appropriate for assessment

Clinical conditions appropriate for referral and assessment in spinal outpatient clinics include:

  • Spinal disorders with accompanying clinical 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)
  • children with scoliosis can be directly referred to the Women’s and Children’s Hospital scoliosis clinic
  • ineligible patients include all overseas students and visitor from countries who do not have a Reciprocal Health Care Agreement with Australia. Ineligible patients may be charged for public hospital services. Compensable patients, for example WorkCover are also not eligible to access this publicly funded service as compensation covers the cost of private medical expenses.

New referral template

In order to manage the large service demand, a referral template was developed to safely triage potential surgical cases.

The spinal outpatient referral template (RTF 2MB) is available both on the SA Health and CALHN website and is mandatory that it is completed and faxed/posted to the RAH Specialist Outpatient Service, along with standard referral information/form.

Please note, if the requested information is not supplied, it will not be possible to triage and accept the referral and it will be returned to your clinic.

Staff at spinal outpatient clinics

Consultant staff

Telephone: (08) 7074 2036

  • Yun-Hom Yau
  • David Hall
  • Yu Chao Lee
  • Matthew Rackham
  • Aaron Stevenson
  • Chris Tsimiklis
  • Simon Sandler

Lead Physiotherapist

Matthew Beard
Telephone: (08) 7074 2033

Physiotherapy staff

Telephone: (08) 7074 2033

  • Sooraj Venugopalan
  • Abi Ehrlich
  • Mark Jarrett
  • Ali Wigg
  • Madelaine Carey
  • Cameron Cramey
  • Katie Wyschnja

Orthopaedic spinal outpatient services

Spinal Surgical Clinic Orthopaedic/Outpatient Department, RAH

Staff attending: Orthopaedic spinal consultants/fellows/registrars
Admin contact details:
Telephone: 1300 153 853 or
Fax: (08) 7074 6247 

Spinal Assessment Clinic Orthopaedic/Outpatient Department, RAH

Staff attending: Senior physiotherapy staff
Admin contact details: 
Telephone: 1300 153 853 or
Fax: (08) 7074 6247 

Spinal Assessment Clinic, TQEH

Staff attending: Senior physiotherapy staff
Admin contact details:
Telephone: (08) 8222 7010 or
Fax: (08) 8222 7188

Sefton Park Primary Healthcare Centre

Staff attending: Senior physiotherapist
Admin contact details:
Telephone: (08) 8342 8600 or (08) 7074 2033

Appointment locations

Royal Adelaide Hospital (RAH)

Outpatient Department, Level 3G.6.
Royal Adelaide Hospital
Port Road SA 5000

The Queen Elizabeth Hospital (TQEH)

Orthopaedic Outpatients, Ground floor, Area 3
The Queen Elizabeth Hospital
28 Woodville Road, Woodville SA 5011

Sefton Park Primary Health Care Services

Shop 5/221 Main North Road.
Sefton Park SA 5083

Clinical categories/process

Immediate priority

Condition requires immediate surgical consultation.

Spinal examples (not an exhaustive list) include:

  • Acute Cauda Equina Syndrome
  • Severe/rapidly progressing neurological deficits.

Refer immediately to the Emergency Department or contact the spinal fellow or neurosurgery registrar at the RAH: (08) 7074 0000.

Urgent priority

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 examples (not an exhaustive list) include spinal disorder with accompanying red flags identified (such as tumour, infection)

Refer to the Spinal OPD with spinal referral template and standard referral. Then Fax to OPD referral management: (08) 7074 6247 and clearly mark referral as urgent.
In addition, cases can be discussed with the spinal fellow via RAH switchboard on (08) 7074 0000.

Semi urgent priority

Condition has the potential to have some impact on surgical outcome if assessment is delayed.

Spinal examples (not an exhaustive list) include:

  • 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.

Non-urgent priority

Condition is unlikely to deteriorate quickly or require more complex care if assessment is delayed.

Spinal examples (not an exhaustive list) include:

  • Patients with non-specific low back pain who are considering surgical treatment.
  • Significant deformity/scoliosis.

Refer to the Spinal OPD via referral template. Fax to referral management: (08) 7074 6247. Consider options for community-based management as appropriate.

Specialist consultation rarely required

Condition is unlikely to benefit from surgical intervention.

Spinal examples (not an exhaustive list) include:

  • strain/sprain
  • spondylosis, discogenic pain
  • facet joint arthropathy
  • osteoporotic compression fractures
  • spondylolysis/spondylolisthesis.

Referral not accepted: consider further options for community-based management or alternative specialist involvement.

Patient information

With our information sheets, patients can learn about what they can do to assist recovery from low back pain and sciatica. They are available to view and download via the low back pain section on the SA Health website.

More information is available in the Spinal Assessment Clinic guide to appointments (PDF 674KB).

Online clinician resource

In order to enhance optimal and comprehensive management of patients with acute lumbar disorders presenting to primary care, there is an online resource available. It is available on the SA Health internet site and can be accessed at www.sahealth.sa.gov.au/lumbardisorders

Spinal information sheets

More information

Royal Adelaide Hospital
Port Road, Adelaide, SA, 5000

Telephone: 1300 153 853
Fax: (08) 7074 6247
Email: HealthRAHspine@sa.gov.au