Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- suspected cauda equina syndrome:
- perianal anaesthesia
- new onset incontinence
- progressive lower limb weakness
- perianal anaesthesia
- spinal fracture/trauma with significant deformity, and/or neurological deficit, instability
- clinical suspicion of spinal infection
- high risk of irreversible deficit if not assessed urgently for example, if onset of motor deficit of at least < 4/5 has been present for < 72 hours
- spinal tumour with significant pain and/or neurological deficit
Please contact the on-call registrar to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant specialty service.
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Exclusions
- congenital scoliosis – refer to Central Adelaide Local Health Network orthopaedic spinal unit Spinal (adult) CPC
- spinal fracture referrals within Central Adelaide Local Health Network and Northern Adelaide Local Health Network – refer to orthopaedic surgery Spinal (adult) CPC
- musculoskeletal spinal pain with systemic inflammatory disorder referrals, confirmed by symptoms or pathology tests - refer to rheumatology
- non-specific axial spinal pain
Triage categories
Category 1 (appointment clinically indicated within 30 days)
- any intradural lesion including vascular malformations with stable symptoms or without symptoms
- progressive cervical or thoracic myelopathy - progressive neurological deficit with cord signal abnormality on magnetic resonance imaging (MRI)
- radiculopathy with motor neurological deficit of < 4/5 that has been present < 4 weeks
- syringomyelia with neurological deficits
- acute spinal fractures Southern Adelaide Local Health Network (SALHN) catchment only
Category 2 (appointment clinically indicated within 90 days)
- radiculopathy with motor neurological deficit that has been present and remained stable > 4 weeks
- subacute spinal fractures or delayed presentation SALHN catchment only
Category 3 (appointment clinically indicated within 365 days)
- radiculopathy without neurological deficit, or with isolated sensory deficit
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
For essential referral information specific to spinal referrals to Neurosurgery please refer to the referral forms in the links below:
Clinical management advice
All referrals for spinal fractures within Central Adelaide Local Health Network (CALHN) and Northern Adelaide Local Health Network (NALHN) catchments are to be referred to the statewide Orthopaedic spinal service. All referrals for spinal related conditions including spinal fractures within the Southern Adelaide Local Health Network (SALHN) catchment are to be directed to SALHN Neurosurgery.
Most category 2 and 3 patients referred for a surgical opinion do not require surgery; evidence demonstrates that non-surgical management is effective for the majority of spinal conditions.
In order to preserve surgical outpatient capacity for high acuity cases several alternate service models have been adopted, including assessment clinics provided by advanced practice physiotherapists.
Appropriate category 2 and 3 patients may be assessed and managed by an advanced practice physiotherapist; outcomes may include provision of non-surgical management options for primary care, further imaging/spinal interventions where indicated, and referral for definitive surgical opinion.
Most category 3 patients will not be offered a formal appointment (where patients are unlikely to benefit from a lengthy wait for spinal outpatient consultation); instead, these patients may be managed with an advance practice physiotherapist and/or with written advice/recommendation for ongoing management in primary care provided to referring clinician following formal review of referral and spinal imaging.
Concerning features may include:
- recent significant trauma
- unexplained weight loss
- history of cancer/malignancy
- prolonged corticosteroid use
- severe, worsening pain; especially at night
- fever
- recent serious illness/significant infection
Any concerns may be discussed with the on call registrar at the relevant hospital.
Clinical resources
- Statewide Orthopaedic Spinal Service - Acute Cauda Equina Syndrome (PDF 60KB)
- Statewide Orthopaedic Spinal Service - Non-specific spinal pain (PDF 61KB)
- Statewide Orthopaedic Spinal Service - Cervical or thoracic myelopathy (PDF 118KB)
- Statewide Orthopaedic Spinal Service - Lumbar spinal claudication (PDF 60KB)
- Statewide Orthopaedic Spinal Service - Spinal disorder with suspected inflammatory component (PDF 60KB)
- Statewide Orthopaedic Spinal Service - Spinal radiculopathy (PDF 62KB)
Consumer resources
- Statewide Orthopaedic Spinal Service - Active pain management (PDF 186KB)
- Statewide Orthopaedic Spinal Service - Advice for managing low back pain (PDF 1148KB)
- Statewide Orthopaedic Spinal Service - Advice for managing sciatica (PDF 850KB)
- Statewide Orthopaedic Spinal Service - Oxycodone for short-term management of acute pain (PDF 148KB)
- Statewide Orthopaedic Spinal Service - Scans and low back pain (PDF 446KB)
Reason for request
- to establish a diagnosis
- for treatment or intervention
- for advice and management
- for specialist to take over management
- for a specified test/investigation the General Practitioner cannot order
- for other reason (e.g. rapidly accelerating disease progression)
- transfer of care from another tertiary service
- clinical judgement indicates a referral for specialist review is necessary.
Patient demographic details
- full name, including aliases
- date of birth
- residential and postal address
- telephone contact number/s – home, mobile and alternative
- Medicare number, where eligible
- name of the parent or caregiver, if appropriate
- preferred language and interpreter requirements
- identifies as Aboriginal and/or Torres Strait Islander
Clinical modifiers
- impact on employment
- impact on education
- impact on home
- impact on activities of daily living
- impact on ability to care for others
- impact on personal frailty or safety
- identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery, where surgery is a likely intervention.
- Choice to be treated as a public or private patient.
- Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
- Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
- Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
- Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
- A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
- All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.