Breadcrumbs

Spinal outpatient services in Central Adelaide

Changes to the Orthopaedic Spinal Service

To improve access to spinal services for appropriately triaged patients and furthermore enhance the management of spinal disorders in primary care, changes have been implemented as outlined below:

  • Cases of Acute Cauda Equina Syndrome or patients with severe/rapidly progressing neurological deficits should NOT be referred to outpatients clinics.
  • These patients should be referred directly to the Royal Adelaide Hospital (RAH) Emergency Department or call the RAH switchboard on (08)7074 0000 and ask for the spinal fellow/registrar on-call to discuss the patient.

Outpatient information

The Spinal Outpatients Clinic provides specialist services for patients with spinal disorders who are referred for assessment by a medical practitioner, and via internal referrals. The spinal clinics offer services 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.

Clinics are located at:

Royal Adelaide Hospital (RAH) 
(08) 7074 0000
The Queen Elizabeth Hospital (TQEH)
(08) 8222 2600
Sefton Park Primary Healthcare Centre (08) 8342 8600
GP Super-Clinic Modbury 
(08) 7245 8700 

Contact details 

  • Referrals should be faxed to (08) 7074 6247
  • All referrals should be made with a standard referral and should be sent with a competed spinal outpatient referral template (PDF 40KB)
  • Appointments will not be allocated until an appropriate referral is received
  • For further information / appointment queries, contact the Outpatient Call Centre on 1300 153 853

Wayfinding (Orthopaedic Department/spinal outpatients (in the RAH)

  • 3G Waiting Area 6.2

Patient triage

All referrals to spinal outpatient clinics are quickly assessed to determine urgency prior to appointment allocation. The aim is to assess patients in clinically appropriate time frames based on triage category. 

  • A triage system identifies priority cases which are usually allocated an appointment in the Spinal Surgical Clinic.
  • Some of the remaining non-urgent cases are allocated to the Spinal Assessment Clinic at the RAH/TQEH or an outreach site.

Please note, non-urgent cases that do not require specialist assessment may not be offered an appointment (based on referral information).

Referrals from Emergency Department to spinal outpatients

  • Emergency Department (ED) staff can directly refer patients to spinal outpatient clinics only with prior approval from a spinal consultant/fellow/registrar.
  • Access to spinal 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.

Our services/procedures

Spinal outpatient services comprise two clinic types:

  • Spinal Surgical Clinic (SSC)
    These clinics operate from the RAH/TQEH 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.
  • Spinal Assessment Clinic (SAC)
    Patients identified as warranting non-urgent surgical consultation are seen in the SAC. The SAC currently operates from 4 sites within the Central Adelaide Local Health Network (CALHN) and Northern Adelaide Local Health Network (NALHN) and provides assessment and management services for patients with spinal disorders. Physiotherapists and a general practitioner who work in advanced practice roles consult in these clinics, with support provided by spinal consultants as required.

Spinal outpatient appointments

The objective of a spinal 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.

Orthopaedic Spinal Services at RAH

General Practitioners referring their patients to Orthopaedic Spinal Services must complete the referral form below:

It is mandatory that the form is completed and faxed or posted to RAH Spinal Outpatient Services (see the form for details). Failure to do so will result in the referral being returned for completion prior to processing and triage.

Clinical conditions appropriate for assessment

Clinical conditions appropriate for referral and 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: What we don’t see/conditions excluded from service

Clinical conditions not appropriate for assessment in spinal 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)
  • 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, for example WorkCover are also not eligible to access this publicly funded service as compensation covers the cost of private medical expenses.

New referral template

In order to manage the large service demand, a referral template was developed to safely triage potential surgical cases.

  • The  spinal outpatient referral template (PDF 40KB) is available both on the SA Health and CALHN website and is mandatory that it is completed and faxed/posted to the RAH Specialist Outpatient Service, along with standard referral information/form.

Please note, if the requested information is not supplied, it will not be possible to triage and accept the referral and it will be returned to your clinic.

Head of service and staff for spinal outpatient clinics

Position title Name Contact number
Clinical Director and Head of unit Professor Brian Freeman (08) 7074 2036
Consultant staff Yun-Hom Yau
David Hall
Mike Selby
Catherine Cartwright
Simon Sandler
(08) 7074 2036
Lead Physiotherapist Matthew Beard (08) 7074 2033
Physiotherapy staff Sooraj Venugopalan
Abi Ehrlich
Mark Jarrett
Ali Wigg
Scott Main
Andrew Chapman
Cameron Cramey
(08) 7074 2033
General practitioner Dick Lister

Orthopaedic spinal outpatient services

Site location Staff attending Contact details
Spinal Surgical Cinic
Orthopaedic/Outpatient Department
Orthopaedic spinal consultants
/fellows/registrars

Tel: 1300 153 856
Fax: (08) 7074 6247
Spinal Assessment Clinic
Orthopaedic/Outpatient Department, RAH
Spinal consultant and senior physiotherapy staff
Spinal Surgical Clinic, TQEH Orthopaedic spinal consultants/fellows
/registrars, 
general practitioner, spinal consultant and senior physiotherapy staff
Tel: (08) 8222 7010
GP Super-Clinic Modbury Senior physiotherapist Tel: (08) 7425 8711
Sefton Park Primary Healthcare Centre Senior physiotherapist Tel: (08) 7074 2033

Clinical categories/process

Immediate priority Spinal examples (not an exhaustive list)
Condition requires immediate surgical consultation.
  • Acute Cauda Equina Syndrome
  • Severe/rapidly progressing neurological deficits.
Refer immediately to the Emergency Department or contact the spinal fellow or neurosurgery registrar at the RAH: (08) 7074 0000.
Urgent priority Spinal examples (not an exhaustive list)
Condition 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.
  • Spinal disorder with accompanying red flags identified (such as tumour, infection)
Refer to the Spinal OPD with spinal referral template and standard referral. Then Fax to OPD referral management: (08) 7074 6247 and clearly mark referral as urgent.
In addition, cases can be discussed with the spinal fellow via RAH switchboard on (08) 7074 0000.
Semi urgent priority Spinal examples (not an exhaustive list)
Condition has the potential to have some impact on surgical outcome if assessment is delayed.
  • Radiculopathy, not improving after 4-6 weeks and surgery is being considered.
  • Spinal Claudication with symptoms of sufficient duration and severity for patient to consider surgery.
Non-urgent priority Spinal examples (not an exhaustive list)
Condition is unlikely to deteriorate quickly or require more complex care if assessment is delayed.
  • Patients with non-specific low back pain who are considering surgical treatment.
  • Significant deformity/scoliosis.
Refer to the Spinal OPD via referral template. Fax to referral management: (08) 7074 6247. Consider options for community-based management as appropriate.
Specialist consultation rarely required Patients with non-specific spinal pain including:
Condition is unlikely to benefit from surgical intervention.
  • strain/sprain
  • spondylosis, discogenic pain
  • facet joint arthropathy
  • osteoporotic compression fractures
  • spondylolysis/spondylolisthesis.
Referral not accepted: consider further options for community-based management or alternative specialist involvement.

Patient information

With our information sheets, patients can learn about what they can do to assist recovery from low back pain and sciatica. They are available to view and download via the low back pain section on the SA Health website.

More information is available in the Spinal Assessment Clinic guide to appointments (PDF 674KB).

Online clinician resource

In order to enhance optimal and comprehensive management of patients with acute lumbar disorders presenting to primary care, there is an online resource available. It is available on the SA Health internet site and can be accessed at www.sahealth.sa.gov.au/lumbardisorders

Spinal information sheets

More information

Royal Adelaide Hospital
Port Road, Adelaide, SA, 5000

Telephone: 1300 153 853
Fax: (08) 7074 6247
Email: HealthRAHspine@sa.gov.au

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