Spine (Neurosurgery)
Adult

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Non-acute skull fracture/ non- acute traumatic brain injury
- Acute trauma
- Change in consciousness level or deteriorating neurological function
- Head trauma with seizures
Brain tumours (intracerebral, meningioma, skull base, pituitary)
- Symptoms of signs of raised intracranial pressure
- Severe and increasing headache
- Deteriorating neurological function
- Seizures
Neurovascular disorders (aneurysm, arteriovenous malformation, AVMs, other)
- Symptoms of signs of raised intracranial pressure
- Severe and increasing headache
- Deteriorating neurological function
- Seizures
- Clinical suspicion or subarachnoid haemorrhage or intracerebral haemorrhage
Hydrocephalus and ventriculoperitoneal VP shunt
- Symptoms of signs of raised intracranial pressure
- Increasing severity of headache
- Deteriorating neurological function
- Seizures
- Swelling pain or redness along shunt tract
- Abdominal pain or swelling
- Clinical suspicion of shunt infection
Trigeminal neuralgia and other cranial nerve abnormalities
- Severe intractable pain preventing adequate fluid intake
Spine
- Actual or threatened cauda equina syndrome
  - bilateral nerve pain (leg pain below knees)
  - unexplained or unexpected loss of bladder or bowel function
  - perineal anaesthesia
  - progressive weakness
- Spinal tumour with significant pain and/or neurological deficit
- Clinical signs spinal nerve root compression or spinal cord compression with rapidly progressive neurological signs/symptoms
- Spinal trauma with significant pain and/or neurological deficit
- Spinal fractures demonstrated on imaging
- Clinical suspicion of spinal infections
- High risk of irreversible deficit if not assessed urgently

Peripheral nerve compression with acute neurological deficit including carpal tunnel syndrome, ulnar nerve entrapment neuropathy, common peroneal and lateral cutaneous nerve of thigh compression syndromes

Other referrals to emergency not covered within conditions:

Collapse/altered level of consciousness/new neurological deficit
Suspected subarachnoid haemorrhage or other intracranial haemorrhage
Headache with concerning features:
- sudden onset/thunderclap headache
- severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
- first severe headache age over 50 years
- severe headache associated with recent head trauma
Symptomatic benign or malignant space-occupying lesion
Suspected or proven blocked or infected VP shunt
Acute hydrocephalus
Head injuries/trauma including extensive scalp laceration or suspected traumatic brain injury
Trigeminal neuralgia – severe uncontrollable pain

Useful Management Information

Determine the potential for underlying sinister pathology
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
Most Category 2 and 3 patients referred for a surgical opinion do not require surgery. Evidence demonstrates that 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 who work as a member of the Neurosurgical team and work in coordination with Neurosurgical consultants. Outcomes may include provision of appropriate non-surgical management plans, discussion or appointment with a spinal surgeon or discharge.

Management

Caution should be used in prescribing opiates for spinal pain which should be prescribed in line with current guidelines, always consider simple analgesia or anti-inflammatories as first line
Advice, education and reassurance
Heat, gentle activity and avoid resting in bed
Physiotherapy and exercise
Complete ‘Keele STarT Back’ screening tool to identify risk of developing chronic spinal pain [2, 6]
Low to medium risk suggests ongoing management in primary care maybe appropriate
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. (Imaging pathways )

Patient resources

Chartered Society of Physiotherapy: 10 things you need to know about your back
Qld Health Emergency Department Fact Sheet

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Risk irreversible deficit if not seen within 1-4 weeks Significant spinal nerve root compression or spinal cord compression with evolving neurological deficit 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 Slowly evolving cauda equina
Category 2 (appointment within 90 calendar days)	Appropriate category 2 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal clinician through the Neurosurgical Physiotherapy Screening Service in consultation with a Neurosurgical consultant. 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 calendar days)	Appropriate category 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal clinician through the Neurosurgical Physiotherapy Screening Service in consultation with a Neurosurgical consultant. Chronic cervical and lumbar disc prolapse and degenerative spinal disorders without progressive neurological deficit Age related degenerative changes with no neurological deficit
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: 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.

Standard Referral Information

Reason for request

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

Relevant clinical information about the condition

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
All conservative options that have been pursued unsuccessfully prior to referral
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
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

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.)

Essential Referral Information

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
Relevant imaging reports (may include plain x-ray, CT and MRI)

Additional Referral Information

Other relevant reports from any providers in a public or private sector related to the presenting problem
FBC, ELFT, ESR, CRP results, rheumatoid serology, Calcium and phosphate, electrophoresis, immunoglobin’s, PSA (if relevant)
For any lumbar spondylolisthesis plain lateral standing films in flexion and extension are helpful in addition to the CT/MRI
Spinal referral questionnaire
Nerve conduction studies

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Neurosurgery (E-Blueslips)

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Teresa Withers

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Spine (Neurosurgery)Adult