Name: SA Health
Price range: $

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.

Contact Details:
RAH (08) 7074 0000	Fax Number (08) 7074 6247
Outpatient Call Centre 1300 153 853	Wayfinding: 3G.2 Area 6

Referral Process Triage

All referrals to 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 be sent with the SPINAL OUTPATIENT REFERRAL FORM.

It is mandatory for completed forms to be faxed or posted to RAH Spinal Outpatient Services. Failure to do so will result in the referral being returned for completion prior to processing and triage.

Appointments will not be allocated until an appropriate referral is received

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. 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

Clinical Categories

Clinical Categories/Process
Immediate Priority	Spinal Example (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 call the spinal fellow or neurosurgery registrar.	(08) 7074 0000
Urgent Priority	Spinal Example (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 and clearly mark referral as urgent.	(08) 7074 6247
In addition, cases can be discussed with the spinal fellow via RAH switchboard	(08) 7074 0000
Semi Urgent Priority	Spinal Example (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.
Refer to the Spinal OPD via referral template. Fax to referral management. Consider options for community-based management as appropriate	(08) 7074 6247
Non-Urgent Priority	Spinal Example (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. Consider options for community-based management as appropriate.	(08) 7074 6247
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	Referrals that are incomplete, or would be better managed by an alternative specialty will not be accepted Following careful clinical triage, if an appointment within the Spinal Service Clinics is not clinically indicated, the referral will not be accepted. These referrals will however be managed via a Virtual Clinic (see further details below)

Expected Waiting Time

Online Clinician Resource

Spinal Information Sheets

Our services/procedures

Spinal Outpatient Services

Spinal outpatient services comprise of the following services:

Spinal Surgical Clinic (SSC) This clinic operates from the RAH and is staffed by spinal consultants/fellows and registrars is for the management of priority cases. Most commonly, this includes the assessment of patients who are triaged as being urgent or semi-urgent candidates for probable surgical intervention.
Spinal Assessment Clinic (SAC) Patients identified as warranting non-urgent consultation are allocated to the SAC. The service currently operates from 3 sites within the Central Adelaide Local Health Network (CALHN) and also delivers a suite of Telehealth services for both metro and country patients. The SAC provides assessment and surgical triage for patients with certain spinal disorders. These clinics are staffed by physiotherapists who work in an advanced practice role, with support provided by spinal surgeons as required.
Spinal Virtual Clinics: for referrals that are not accepted following careful clinical triage, then management advice and review is offered via a Virtual Clinic. This will involve referrals who are triaged as unlikely to require surgery or those simple spinal fracture cases that can be safely managed remotely.
This process involves:
- review the GP referral and relevant radiology reports
- an assessment in the context of patient’s reported signs and symptoms, history and relevant imaging
- provision of customised clinical advice via a letter to the referring GP that may include conservative management options or appropriate surveillance imaging.

Spinal Outpatient Staff
Head of Unit	Aaron Stevenson	(08) 7074 2036
Consultant Staff	Catherine Cartwright David Hall Yu Chao Lee Matthew Rackham Simon Sandler Meenalochani Shunmugam	(08) 7074 2036
Lead Physiotherapist	Matthew Beard	(08) 7074 2033
Physiotherapy Staff	Madelaine Carey Cameron Cramey Abi Ehrlich Mark Jarrett Katelyn MacNab Joseph Orlando Sooraj Venugopalan	(08) 7074 2033

Spinal outpatient appointments

Spinal 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.

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 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 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 DEPARTMENT

Emergency Referrals

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.

Is the emergency department the best place for you?

Spinal