For Patients and Visitors
Northern Health has an Outpatient Orthopaedic Spinal Service for people with neck and back (spinal) problems. We are a team made up of Advanced Practice Physiotherapists, an Orthopaedic Spinal Consultant and Outpatient staff.
The most common reason that people are referred to us is for back pain that feels like the pain travels into the leg (often called “sciatica”). The other common problem that we see people for is for neck pain and arm pain. It is important for people with back pain to know that surgery is not a cure for back pain. If your scan report shows “disc bulges”, “disc herniations”, or other words like this – this does not mean you need an operation- which is great news!
If you are experiencing pain in your spine (back/neck) then you should see your GP and a physiotherapist because over 90% of people with spinal pain (even if it travels into your arm/leg), will get better with general advice and physiotherapy. The great news is that over 90 per cent of people don’t need surgery.
What can I expect from the service?
You will be referred to us by your GP or by a specialist unit from the hospital. We are a resource for people with pain and disability that your local GP or community physiotherapy cannot manage.
Our team works with you to find out about your problem. We will make a treatment plan for you together.
When you come to this clinic, you will be seen by the Advanced Practice Physiotherapist (AMP). This physiotherapist is specially trained to help you. This physiotherapist works with the Orthopaedic consultant to get you the best plan so only patients who need surgery will see the Orthopaedic consultant. See below for information about an AMP.
To be completely assessed
- Further tests can be organised if you need more tests
- You will get a “Clinical diagnosis” and explanation of your problem
- You will get a Specialist opinion regarding the most appropriate treatment
- If you need surgery, we will organise the admission
- Your referring GP will get a letter from us explaining your case and the management plan our team has developed with you
What do I bring/need for my appointment?
Please bring the following to your appointment:
- Formal reports of your CT/MRI scan images giving the name of the Radiology provider.
Note: We are unable to view scans on disc in outpatients clinics. - A copy of your full past medical history (including any previous surgeries)
- All current medications (for pain or other medical conditions)
- Copies of any letters you may have from other specialists you have seen
Contact us
For an appointment, you need to referral letter from your GP. If you need to cancel or reschedule an appointment please call 8405 8335 or email SpecialistClinics@nh.org.au. For other enquiries you may call Northern Hospital main switchboard 8405 8000. General Enquiries via Northern Health Switch: (03) 8405 8000. If you have a medical emergency please call 000
For Health Professionals
Important note: Northern Health does not see any referrals for intracranial pathology. This is a dedicated spinal service only. Please see inclusion and exclusion criteria below.
Service Overview
Our Orthopaedic Spinal Team is an elective, outpatient service for patients with spinal pain/disorders
- We do not accept intra-cranial pathology – consider Austin Health
- Please see the inclusion/exclusion criteria below
- Patients requiring surgical intervention are placed onto the surgical list at Austin Health and undergo this procedure +/- hospital stay there.
- Patient’s requiring non-surgical management options including selective nerve root injections can be managed within Northern Health.
- Patients will be assessed, diagnosed and often managed by the Advanced Practice Physiotherapist (AMP). Our patients are managed in a collaborative shared-care model between AMP and Consultant Orthopaedic Spinal Surgeon. This model prevents duplication of work, allowing for higher patient numbers to be seen.
Essential Considerations for referring GPs:
- Please closely review the conditions requiring urgent opinion prior to referral
- We recommend all referring clinicians utilise HealthPathways Melbourne to assist in:
1. Assessment considerations, red flags and diagnostic tests.
2. Considerations for the early conservative management of patients with spinal pain/disorders.
3. Medicare rebates now apply for MRI of the cervical spine, requested via GP for patients > 16 years of age and symptoms of cervical radiculopathy or trauma. When unable to obtain MRI, CT imaging must be included in referral
INCLUSION/EXCLUSION CRITERIA
Absolute exclusions as follows:
- Children < 16 years of age
- Patients treated at another Victorian hospital for same complaint
- Spinal surgery previously at another Victorian hospital
- Spinal fractures including coccygeal fractures
- Suspected inflammatory back pain (consider rheum referral)
- Coccydynia
Conditions requiring URGENT spinal surgical opinion (also absolute exclusions):
If you are concerned that your patient has any of the following then we recommend immediate discussion with the Spinal on-call Registrar at Austin Health, +/- review in ED at Austin Health
Back Pain with significant red flags:
- Clinical symptoms of cauda equina syndrome
- Cord / Conus medullaris compression
- Rapidly progressing neurological deficit
- Osteomyelitis
- Discitis
- Metastatic Cancer
Neck pain with significant red flags
- Rapidly progressing neurological deficit upper or lower limb
- Acute fractures
- Osteomyelitis
- Discitis
- Metastatic Ca
Other EXCLUSION CRITERIA
Simple Backache:
- Localised to lumbosacral/buttocks
- Mechanical pain and absence of red flags (irrespective of imaging findings or “disc bulges”)
- Consider imaging only if not improved after 6 weeks conservative therapy
- Should be seen by physiotherapy for targeted rehabilitation
If no improvement with simple outpatient physiotherapy, consider opinion from Northern Pain Clinic. N.B Patients can be referred from Pain Clinic for Spinal Surgery review as required.
INCLUSION CRITERIA
Progressive Lower back pain – refer to Statewide Referral Criteria (click on link below)
https://src.health.vic.gov.au/progressive-lower-back-pain
Back pain with
Referral into the leg (radiculopathy/sciatica) and corresponding imaging findings
- With associated neurological deficit will be seen as priority
- Painful nerve root compression to be seen as routine next available
Back pain with:
Central canal stenosis and limitation of walking distance (neurogenic claudication)
Neck pain with:
- Referral into arm (radiculopathy) and corresponding MRI findings
- Signs and symptoms of stable/chronic cervical cord compression
- Confirmed compressive cervical myelopathy on MRI (mark as urgent on referral)
Imaging Recommendations in Primary Care:
- Routine imaging is not indicated in most cases of spinal pain
- There is no evidence that investigation provides reassurance and a better outcome
- Findings of degenerative changes correlate poorly with pain
- Many people without symptoms show abnormalities on X-rays and MRI
- The chances of finding coincidental disc prolapse increase with age
- If symptoms persist > 6/52 or red flags on examination (see red flag screening below). MRI is the diagnostic test of choice for spinal pain
MRI of the cervical spine is bulk-billed via GP referral for “suspected cervical radiculopathy” or “suspected cervical spine trauma”. See Medical Imaging for GPs
Team:
The Northern Spinal Outpatient Service is comprised of an Advanced Practice Musculoskeletal Physiotherapist (AMP) and an Orthopaedic Spinal Consultant:
Mr. Nathan Anderson – Orthopaedic Spinal Surgeon
Mr. Anderson is a locally trained Orthopaedic surgeon who has completed further subspecialist training in spinal surgery. He consults from the Northern Hospital every Tuesday. He graduated from the University of Melbourne Medical School in 2010 and went on to complete training as an Orthopaedic Surgeon through the Victorian Orthopaedic Training program, through the Royal Australasian College of Surgeons and Australian Orthopaedic Association. He has undertaken subsequent sub-specialty training in Complex Spinal Surgery in Brisbane and Melbourne.
Mr Paul Jackson – Advanced Musculoskeletal Physiotherapist (AMP) & Clinical Leader of Advanced Practice Physiotherapy, Northern Health.
Paul has worked in AMP roles for many years alongside various specialist medical teams. He has a Bachelor of Physiotherapy and a Masters of Musculoskeletal Physiotherapy.
Ms Bridget Shaw – Advanced Musculoskeletal Physiotherapist (AMP) & current Chair of the Australian Physiotherapy Association Advanced Practice Physiotherapy Group in Victoria
She has worked for many years in AMP roles alongside various specialist medical team and has a Bachelor of Applied Science (Physiotherapy) and a Masters of Manipulative Physiotherapy. She is a member of the Australian College of Physiotherapy.
How to Refer:
Acutely unwell patients should be directed to the nearest Emergency Department.
GP Referrals: Use Healthlink to send referrals, results and reports. For more information click here.
Other Health Service Referrals: (hospitals, allied health, specialists etc): Fax your referral to 8405 8616.
Mandatory information that must be included in the referral;
Relevant diagnostic investigation results (medical imaging/pathology) – full copy is required, do not copy & paste the result. Patients should bring their radiology reports to appointments with name of Radiology PROVIDER
- The reason and purpose for the referral
- Current management of the condition and response to this management
- Current medications and medication history if relevant
- Relevant clinical and past medical history
- Allergies
- Patient details including;
- Postal address,
- Date of birth
- Medicare number
- Contact phone number(s) including mobile
- Interpreter requirement
- Aboriginal and/or Torres Strait Islander status
- Referrer details including provider number
- Usual GP (if different from referring GP)
