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
  • 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 metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

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

For more on outpatient referrals, see the general referral information page.

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.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter required

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

Consumer resources