Spine, Neck, Back Pain
Emergency department referrals
All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:
- Royal Brisbane and Women's Hospital (07) 3646 8111
- The Prince Charles Hospital (07) 3139 4000
- Redcliffe Hospital (07) 3883 7777
- Caboolture Hospital (07) 5433 8888
Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.
If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- Actual or threatened cauda equina syndrome
- Unilateral or bilateral radicular pain
- And/or dermatomal reduced sensation
- And/or myotomal weakness
- Reduced saddle sensation (subjective or objective pin prick)
- unexplained or unexpected loss or change of bladder or bowel function
- Sexual disturbance
- perineal anaesthesia
- Unilateral or bilateral radicular pain
- Presentations that increase the probability of acute threatened Cauda Equina:
- Back Pain with:
- Presence of new saddle anaesthesia, bladder, or bowel disturbance.
- Age < 50
- Unilateral onset progressing to bilateral leg pain
- Alternating leg pain
- Presence of new motor weakness
- Back Pain with:
- Spinal tumour with significant pain and/or neurological deficit
- Lumbar Spine Stenosis (LSS) presenting with clinical symptoms of the following:
- Recurring and insidiously but increasing back pain with gradual onset of unilateral or bilateral lower limb sensory disturbance and/or motor weakness
- Incomplete bladder emptying, urinary hesitancy, incontinence, nocturia or urinary tract infections. Bladder and/or bowel dysfunction may progress gradually over time.
- Clinical signs of spinal nerve root compression or spinal cord compression with rapidly progressive neurological signs/symptoms
- Spinal fractures demonstrated on imaging
- Clinical suspicion spinal infections
- High risk of irreversible deficit if not assessed urgently
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
- Risk irreversible deficit if not seen within 1-4 weeks
- Significant spinal nerve root compression or spinal cord compression with evolving neurological signs/symptoms
- Moderate to severe sciatica with new onset reflex & muscle power deficit eg. Foot drop
- Moderate to severe neck & arm pain with new onset reflex & muscle power deficit
- Spinal tumours (benign or malignant)
- Stable spinal fractures without evolving neurological deficit
Category 2
Appointment within 90 days is desirable
Appropriate category 2 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal physiotherapist
- Severe spinal disorders with significant functional impairment
- Acute cervical & lumbar disc prolapse with moderate to severe radicular symptoms and stable neurological signs
- Documented severe lumbar canal stenosis with significant neurogenic claudication/limitation of walking distance
- Anterolisthesis/spondylolisthesis with lower limb neurology and/or instability on x-rays
- Significant scoliosis in young adult
Category 3
Appointment within 365 days is desirable
Appropriate category 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal physiotherapist
- Chronic cervical and lumbar disc prolapse and degenerative spinal disorders without progressive neurological deficit
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
Other important information for referring practitioners
Not an exhaustive list
- Determine the potential for underlying sinister pathology
- Many Category 2 and most Category 3 patients referred for a surgical opinion will not require surgery. Evidence demonstrates that active non-surgical management is as effective for a number of spinal conditions.
- Appropriate Category 2 and 3 patients will initially be assessed / reassessed, and case managed by an expert musculoskeletal physiotherapist. Outcomes may include provision of appropriate non-surgical management plans, discussion or appointment with a spinal surgeon or discharge.
- Consider referral to Persistent Pain management early as necessary.
Management
- Medication management
- Caution should be used in prescribing opiates for spinal pain which should be prescribed in line with current guidelines
- Anti-inflammatory and analgesia may be considered
- Advice, education, and reassurance
- Heat, activity modification, normal activity
Physiotherapy and exercise
Referral requirements
A referral may be rejected without the following information.
History and Examination
- Presence and duration of neurological signs and symptoms
- Presence or absence of concerning features
- Age (at onset) <16 or > 50 with new onset pain
- Motor deficit e.g. foot weakness
- Recent significant trauma
- Weight loss (unexplained)
- Previous history malignancy (however long ago)
- History of IV drug use
- Previous longstanding steroid use
- Recent serious illness
- Recent significant infection
- Mechanism of injury
- Functional status
- Management to date (including previous spinal surgery and non-operative management)
- General medical history
Imaging and Reports
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 conservative therapy.
- Relevant imaging results
- Xray/CT only where suspected sinister or serious pathology (concerning features)
- MRI for suspected nerve pathology
Additional referral information (useful for processing the referral)
Imaging and Reports
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 conservative therapy.
- For any lumbar spondylolisthesis Plain lateral standing films in flexion and extension are helpful in addition to CT/MRI
- Other relevant reports from any providers in a public or private sector related to the presenting problem
Pathology and Test Results
- FBC, ELFT, ESR, CRP results, rheumatoid serology calcium and phosphate, electrophoresis, immunoglobins, PSA (IF RELEVANT to their presentation)
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- 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
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- 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
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- 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.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org