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Neurosurgery Spinal

 

Outpatient information

The Department of Neurosurgery provides specialist services for patients with spinal disorders who are referred for assessment by a medical practitioner, and via internal referrals.

Neurosurgery offers a service 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.

Contact details

Wayfinding

  • RAH Neurosurgery Outpatient clinics: Wayfinding - 3F 186.10
  • RAH Neurosurgery Spinal Assessment Clinic: Wayfinding - 3G 326.02

Telephone RAH: (08) 7074 000

Fax number: (08) 7074 6247

Outpatient call centre: 1300 153 853

Referral process triage

All referrals to Neurosurgery spinal outpatient clinics are assessed to determine urgency. Referrals are assessed to ensure patients are seen / assessed in clinically appropriate time frames based on triage category.

All referrals to this service MUST contain the following:

  • A clear outline of symptoms
  • A clear summary of medical history and the history of the current complaint
  • A clear outline of physical examination findings. This MUST include an outline of the patient’s neurological examination findings and a clear outline of any neurological deficit
  • A report outlining RECENT radiological examination. A CT scan or MRI is preferable where indicated and where possible. Note there is a Medicare item for some GP initiated cervical spine MRI scans.
  • Copies of any previous specialist’s letters or reports, relating to the spinal compliant

Appointments will not be allocated until an appropriate referral is received

  • A triage system identifies priority cases which are usually allocated an appointment directly in a consultant led clinic.
  • Semi-Urgent and Non-urgent cases are allocated to the Neurosurgery Spinal Assessment Clinic at the RAH. Please note, non-urgent cases that do not require specialist assessment may not be offered an appointment, or may be managed via a Virtual Clinic service (see details below).

Clinical categories/process

Immediate priority
  • Cauda Equina syndrome
  • Radiculopathy/myelopathy with severe/rapidly progressing neurological deficit
  • Post-operative complications such as wound break down, infection, DVT

Refer immediately to the Emergency Department or call the on call Neurosurgery registrar via RAH switchboard Ph(08) 7074 0000

Urgent priority

Spinal disorder with accompanying red flags identified (such as tumour, infection)

A condition that 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.

These cases should be discussed with the Neurosurgery registrar via RAH switchboard Ph (08) 7074 6247

Semi Urgent priority

Radiculopathy, not improving after 4-6 weeks of community based management and surgery is being considered. Spinal Claudication with symptoms of sufficient duration and severity for patient to consider surgery.

Condition has the potential to have some impact on surgical outcome if assessment is delayed.

Refer to the neurosurgery OPD via fax to referral management. Consider options for community-based management as appropriate Fax (08) 7074 6247

Non urgent priority

Patients with non-specific low back pain who are considering surgical treatment. Condition is unlikely to deteriorate quickly or require more complex care if assessment is delayed.

Refer to the neurosurgery OPD via fax to referral management. Consider options for community-based management as appropriate Fax (08) 7074 6247

Specialist consultation rarely required

Condition is unlikely to benefit from surgical intervention.
Patients with non-specific spinal pain including:

  • strain/sprain
  • spondylosis
  • discogenic pain
  • facet joint arthropathy
  • osteoporotic compression fractures
  • spondylolysis/spondylolisthesis

These conditions are usually best managed by the GP using options such as medication and physical therapy.

Referral not accepted

Referrals that are incomplete, or would be better managed by an alternative specialty will not be accepted Following careful clinical triage, if an appointment with neurosurgery is not clinically indicated, the referral will not be accepted.

These referrals may however be managed via a Virtual Clinic (see further details below).

Expected waiting time

Visit the SA Health specialist outpatient waiting time report web page

Spinal clinical information sheets

Neurosurgery spinal services

Consultant outpatient clinics

These clinics operate from the RAH 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.

Consultants (in alphabetical order)

  • Associate Prof. Amal Abou-Hamden
  • Dr Xenia Doorenbosch
  • Dr Simon Sandler (Head of unit)
  • Dr Stephen Santoreneos
  • Dr Adam Wells
  • Associate Prof. Andrew Zacest

On call Registrar/Fellow

Call RAH switchboard (08) 7074 000

Spinal Assessment Clinic (SAC)

Patients identified as warranting semi-urgent or non-urgent surgical consultation are seen in the SAC. The SAC provides assessment and management services for patients with spinal disorders.

Physiotherapists who work in advanced practice roles consult in these clinics, with support provided by the spinal consultants as required. These clinics provide rapid assessment of patients who would normally expect to experience long wait times.

Lead physiotherapist

  • Eamonn McCole
Spinal Outpatient appointments

The objective of a neurosurgical 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.

Clinical Conditions appropriate for assessment

Clinical conditions appropriate for 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

Clinical conditions not appropriate for assessment in Neurosurgery 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)
  • Spinal fractures and adults with scoliosis should be referred to the Orthopaedic Spinal Surgical Service.
  • 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 e.g. WorkCover are also not eligible to access this publicly funded service as compensation covers the cost of private medical expenses.
Referrals from emergency
  • Emergency Department (ED) staff can directly refer patients to Neurosurgery outpatient clinics only with prior approval from a Neurosurgery consultant/fellow/registrar.
  • Access to Neurosurgery 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.

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