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Spine, Neck, Back Pain

Emergency 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.

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 slower evolving neurological signs/symptoms
  • Severe pain with significant functional impairment
  • Suspected spinal tumours (benign or malignant)
  • Moderate to severe sciatica with recent reflex and muscle power deficit eg. foot weakness
  • Moderate to severe neck and arm pain with recent reflex and muscle power deficit

Category 2

Appointment within 90 days is desirable

  • Less severe and more long-standing pain with significant functional impairment
  • Acute cervical & lumbar disc prolapse with stable neurological signs/symptoms
  • Severe degenerative spinal disorders with limitation of activity of daily living (ADL)
  • Acute cervical or lumbar disc prolapse with mod-severe limb pain but minimal neurological deficit
  • Documented severe lumbar canal stenosis with significant neurogenic claudication/limitation of walking distance
  • Acute Pars defect in young adult
  • Anterolisthesis/spondylolisthesis with lower limb neurology and/or instability on flex/ext x-rays

Category 3

Appointment within 365 days is desirable

  • Mechanical lower back pain without lower limb pain
  • Stable mild neurological symptoms/signs which is unlikely to progress if left untreated or in whom a good surgical outcome is uncertain
  • Pain that is manageable or reasonably controlled with analgesia
  • Chronic LBP/neck pain (without leg or arm pain)
  • Most cases of chronic cervical and lumbar disc prolapse and degenerative spinal disorders with no to stable mild neurological deficit
  • Long-standing spondylolisthesis with stable neurology

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

NB: Back pain with red flags – If clinical circumstances indicate the patient requires immediate treatment, refer to emergency.

Sheffield back pain Red Flags:

  • age (at onset) < 16 or > 55
  • motor deficit e.g. foot weakness
  • recent significant trauma
  • unexplained weight loss
  • history of cancer
  • history of IV drug use
  • prolonged use of corticosteroids
  • severe night pain
  • infection/fever
  • Many Category 2 and 3 patients referred for a surgical opinion do not require surgery or a surgical opinion. Evidence demonstrates that non-surgical management is as effective for a number of spinal conditions.
  • Where services are available, category 2 and 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal physiotherapist. Outcomes from this or subsequent review may include discharge, provision of appropriate non-surgical management plans, discussion or appointment with a spinal surgeon.

Management

  • Analgesia/anti-inflammatories/ NSAIDs as appropriate
  • Physiotherapy/hydrotherapy/ back education group (if available) – minimum 6 week program
  • Strengthening exercises and aerobic fitness training
  • Activity modification (remain comfortably active)
  • Heat/gentle massage/acupuncture
  • Monitor neurological function
  • Complete ‘Keele STarT Back’ screening tool to identify risk of developing chronic spinal pain. Low to medium risk suggests ongoing management in primary care is appropriate.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • General referral information
  • Presence and duration of neurological signs and symptoms
  • Weight loss, loss of appetite and lethargy
  • Fever and sweats
  • Management to date (including previous spinal surgery)
  • History of malignant disease / IV drug use
  • Recurrence of injury and mechanism
  • Severity or evolution of injury
  • General medical condition
  • Continence difficulties/sexual function
  • Work status, functional impairment/time of work
  • X-ray results – AP & lateral spine including standing views and CT/MRI results (if available)
  • FBC, ELFT, ESR, CRP results, rheumatoid serology (in specific cases)

Additional referral information (useful for processing the referral)

  • Plain lateral standing X-rays in flexion and extension for lumbar spondylolisthesis
  • Spinal referral questionnaire
  • Calcium and phosphate, electrophoresis, immunoglobins, PSA, Rheumatoid serology (in specific cases)
  • Physiotherapist report

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.)
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