Direct to an emergency department for:
- Clinical signs of spinal nerve root or spinal cord compression associated with rapidly progressive neurological signs or symptoms or suspected cauda equina syndrome
- Present or suspected ruptured abdominal aortic aneurysm
- Suspected spinal infection
- Recent spinal trauma or fracture associated with neurological deficits.
Immediately contact the neurosurgery registrar to arrange an urgent neurosurgery assessment for:
- New diagnosis of spinal tumour with neurological deficits.
Criteria for referral to public hospital service
- Severe or progressive low back pain with either:
- persistent or increasing radicular symptoms despite at least three months of treatment that has included physical therapy, medications (analgesia or corticosteroid injections) and psychological treatment (where required)
- progressive neurological deficit(s) for example, lower limb weakness such as foot drop, abnormal lower limb tone
- worsening neurogenic claudication (reduced walking distance or time)
- signs of serious pathology.
Information to be included in the referral
Information that must be provided
- Reason for referral and expectation, or outcome, anticipated by the patient, or their carer, and the referring clinician from the referral to the health service
- Pain history: onset, location, nature of pain and duration
- If referral relates to injury, detail date, mechanism and severity
- How symptoms are impacting on daily activities including impact on work, study, school or carer role and level of sleep disturbance
- Comprehensive past medical history including any history of:
- previous malignancy
- known abdominal aortic aneurysm
- injectable drug use
- previous long-standing steroid use
- recent serious illness
- recent significant infection
- recent significant trauma
- Details of previous medical and non-medical management including the course of treatments and outcome of treatments
- If progressive neurological deficit, detail duration of neurological signs and symptoms, include affected side
- If neurogenic claudication, radicular symptoms (sciatica) or suspected serious pathology, MRI scans or CT imaging (including date and details of the diagnostic imaging practice).
Provide if available
- Details of any previous spinal surgery, including when and where procedures were performed
- Statement about the patient’s interest in having surgical treatment if that is a possible intervention
- Any recent relevant imaging or investigation results
- Full blood examination
- Inflammatory marker results (erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP))
- Liver function tests
- Glomerular filtration rate (GRF).
The Summary and referral information lists the information that should be included in a referral request.
There are other statewide referral criteria that could also be considered for Inflammatory arthritis, Ankylosing spondylitis (inflammatory back pain), Persistent or chronic secondary musculoskeletal pain and the Health Independence Program chronic pain service.
Where the referral relates to worsening neurogenic claudication referral to a health service that offers neurosurgery services should be considered.
After an initial specialist assessment patients may be transferred to another health service to receive ongoing care or treatment.
MRI scans or CT imaging are not required in the absence of serious pathology and x-rays are not required unless a vertebral fracture is suspected.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
- Low back pain that is not progressive
- Low back pain where at least three months of treatment that has included physical therapy, medications (analgesia or corticosteroid injections) and psychological treatment (where required) has not been trialled
- Referrals based on incidental findings found on imaging without clinical significance.