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.
The Spinal Outpatients Clinic provides specialist services for patients with spinal disorders who are referred for assessment by a medical practitioner, and via internal referrals. The spinal clinics offer services to all patients residing across the metropolitan/country local health networks (LHNs) and some adjacent regions of New South Wales and Victoria for whom SA services are more accessible.
Clinics are located at:
|Royal Adelaide Hospital (RAH)
||(08) 7074 0000|
|The Queen Elizabeth Hospital (TQEH)
||(08) 8222 2600|
|Sefton Park Primary Healthcare Centre||(08) 8342 8600|
|GP Super-Clinic Modbury
||(08) 7245 8700|
- 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 (PDF 40KB)
- 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
Wayfinding (Orthopaedic Department/spinal outpatients (in the RAH)
- 3G Waiting Area 6.2
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.
Spinal outpatient services comprise two clinic types:
- Spinal Surgical Clinic (SSC)
These clinics operate from the RAH/TQEH and are staffed by spinal consultants/fellows and registrars 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 possible surgical intervention.
- Spinal Assessment Clinic (SAC)
Patients identified as warranting non-urgent surgical consultation are seen in the SAC. The SAC currently operates from 4 sites within the Central Adelaide Local Health Network (CALHN) and Northern Adelaide Local Health Network (NALHN) and provides assessment and management services for patients with spinal disorders. Physiotherapists and a general practitioner who work in advanced practice roles consult in these clinics, with support provided by 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 (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:
- GP Referral to Spinal Outpatient Services — printable version (PDF 168B)
- GP Referral to Spinal Outpatient Services — editable version (RTF 2MB)
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: What we don’t see/conditions excluded from service
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 (PDF 40KB) 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.
Head of service and staff for spinal outpatient clinics
|Position title||Name||Contact number|
|Clinical Director and Head of unit||Professor Brian Freeman||(08) 7074 2036|
|Consultant staff||Yun-Hom Yau
|(08) 7074 2036|
|Lead Physiotherapist||Matthew Beard||(08) 7074 2033|
|Physiotherapy staff||Sooraj Venugopalan
|(08) 7074 2033|
|General practitioner||Dick Lister|
Orthopaedic spinal outpatient services
|Site location||Staff attending||Contact details|
|Spinal Surgical Cinic
|Orthopaedic spinal consultants
Tel: 1300 153 856
Fax: (08) 7074 6247
|Spinal Assessment Clinic
Orthopaedic/Outpatient Department, RAH
|Spinal consultant and senior physiotherapy staff|
|Spinal Surgical Clinic, TQEH||Orthopaedic spinal consultants/fellows
/registrars, general practitioner, spinal consultant and senior physiotherapy staff
|Tel: (08) 8222 7010
|GP Super-Clinic Modbury||Senior physiotherapist||Tel: (08) 7425 8711
|Sefton Park Primary Healthcare Centre||Senior physiotherapist||Tel: (08) 7074 2033|
|Immediate priority||Spinal examples (not an exhaustive list)|
|Condition requires immediate surgical consultation.||
|Refer immediately to the Emergency Department or contact the spinal fellow or neurosurgery registrar at the RAH: (08) 7074 0000.|
|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.||
|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||Spinal examples (not an exhaustive list)|
|Condition has the potential to have some impact on surgical outcome if assessment is delayed.||
|Non-urgent priority||Spinal examples (not an exhaustive list)|
|Condition is unlikely to deteriorate quickly or require more complex care if assessment is delayed.||
|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||Patients with non-specific spinal pain including:
|Condition is unlikely to benefit from surgical intervention.||
|Referral not accepted: consider further options for community-based management or alternative specialist involvement.|
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
- Acute Cauda Equina Syndrome (PDF 74KB)
- Non-specific spinal pain (PDF 76KB)
- Spinal myelopathy (cervical or thoracic) (PDF 75KB)
- Spinal claudication (lumbar) (PDF 75KB)
- Spinal disorder with associated red flags (PDF 74KB)
- Spinal disorder with suspected inflammatory component (PDF 76KB)
- Spinal radiculopathy (PDF 78KB).
Royal Adelaide Hospital
Port Road, Adelaide, SA, 5000
Telephone: 1300 153 853
Fax: (08) 7074 6247