​Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • atypical spinal pain with concern for vascular compromise or urgent non-musculoskeletal source of pain (for example ruptured or dissecting abdominal aortic aneurysm or other visceral pathology)
  • spinal trauma or fracture
  • sudden, progressive or serious neurological signs or symptoms, including any of the following:
    • suspected Cauda equina syndrome (for example acute loss of bladder or bowel function due to suspected disc prolapse)
    • myelopathy in upper or lower extremities (for example heavy or weak legs and sudden change in gait, spasticity legs, hyperreflexia including upper motor neurone signs, weakness or clumsiness of hands)
    • rapidly progressive spinal nerve root compression (for example foot drop)
  • suspected spinal infection (for example osteomyelitis, discitis, epidural abscess).

When public outpatient services are not routinely provided

  • Complex, persistent axial spinal back pain where surgical indications are not present.
    Note: consider referral to a rheumatology or multidisciplinary pain service.
  • Patient already on surgical waitlist in another local health district for the same condition.
  • Spondyloarthropathies.
    Note: consider referral to rheumatology.
  • Uncomplicated fragility fractures of the axial spine.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Risk of irreversible deficit if not seen within 1-4 weeks (for example foot drop).
  • Significant spinal nerve root compression or spinal cord compression with worsening neurological signs or symptoms (for example sudden, significant weakness or reflex changes).
  • Spinal tumours (benign or malignant).
  • Stable spinal fractures without worsening neurological deficit.

Category 2
Recommended to be seen within 90 calendar days.

  • Severe back pain with significant functional impairment.
  • Acute lumbar disc prolapse with moderate to severe radicular pain (with or without radiculopathy).

Note: patients are strongly encouraged to have undertaken a trial of non-operative management (for example exercise and physiotherapy, optimisation of health co-morbidities) prior to referral

Category 3
Recommended to be seen within 365 calendar days.

  • Chronic primary back pain without progressive neurological deficit
    Note: consider referral to a rheumatology or multidisciplinary pain service.
  • Documented severe lumbar canal stenosis with accompanying lower limb weakness, pain or paraesthesia impacting walking.

Note: patients are expected to have undertaken a trial of non-operative management (for example exercise and physiotherapy, optimisation of health co-morbidities) prior to referral

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition, including symptoms and their duration, severity, location of pain and impact on function.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions).

If available

  • Presence and duration of neurological signs and symptoms (highly desired).
  • Presence of any of the following concerning features: (highly desired)
    • age (at onset) < 16 or > 50 with new onset pain.
    • myotome weakness (include muscle group or action affected)
    • recent significant trauma
    • unexplained weight loss
    • previous history of malignancy
    • previous longstanding steroid use
    • history of IV drug use
    • recent serious illness
    • recent significant infection.
  • Mechanism of injury (highly desired).
  • Functional status (highly desired).
  • Management to date (including previous spinal surgery and non-operative management) (highly desired).
  • Available, relevant pathology (highly desired).
    Note: consider inflammatory arthropathy, malignancy (primary or secondary) or myeloma prior to referral.
  • Relevant imaging results: X-ray or CT scan only where suspected sinister or serious pathology (concerning features).
  • MRI result for suspected nerve pathology.

Note: Imaging of the spine is not recommended in most patients with an acute presentation or with a stable chronic presentation unless there is the indication of sinister or serious pathology (concerning features). If there are no signs of sinister or serious pathology imaging may be indicated after a trial of non-operative management.

  • Medical and/or allied health reports.
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ or among a vulnerable, disadvantaged or priority population.
  • If the patient is willing to have surgery (where clinically relevant).
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.


 

Current as at: Thursday 14 November 2024
Contact page owner: System Purchasing