Low Back Pain

Availability

North South North West Statewide

Pre-referral work-up

History

The Neurosurgery Department does not include a Chronic Pain Service.

Patients with mechanical lower back pain not requiring surgery should be referred to a more appropriate service, such as Spinal Assessment ClinicRheumatology, Acute Low Back Pain Drop In Clinic or a local physiotherapist. – See Scope

All referrals should comply to referral standards and include in particular:

  • Duration of symptoms
  • Presence of neurological symptoms and signs
  • Functional impairment including time off work
  • Systemic symptoms
  • Treatment to date including previous spinal surgery or malignant disease
  • Height, weight and BMI

Tests

Investigations, if symptoms persist:

  • Plain x-rays and CT/& or MRI (MRI preferable if available)
  • FBC/CRP/ESR
  • Biochemistry

(Consider calcium and phosphate, electrophoresis, immunoglobulins, PSA, rheumatoid serology in specific cases).

Interim/GP management

To refer a patient with this condition, please see the Neurosurgery clinic page for the full referral process and templates.

Refer to Clinical Guidelines for the management of Acute Low Back Pain

In the absence of the emergency or urgent symptoms listed below patients should only be referred if pain persists in spite of adequate management. See Scope.

Consider also Spinal Assessment ClinicRheumatology, Acute Low Back Pain Drop In Clinic or a local physiotherapist.

For more information please see the Tasmanian Health Pathways website.

Emergency

Cauda equina Syndrome (back pain with neurological and bladder involvement)
Bilateral nerve pain (leg pain going below knees)
Bladder/bowel dysfunction
Perineal anaesthesia
Progressive weakness
Foot drop with Cauda Equine Syndrome

Urgent / category 1

Back pain secondary to neoplastic disease or infection
 Possible serious Spinal Pathology
Foot drop <2/52 

Consider prompt referral (less than six weeks):
Unilateral pain (usually going below knee) and weakness or loss of reflex
Features of systemic illness (history of carcinoma, steroid, use, HIV, unexplained weight loss, fever or raised CPR/ESR/WCC without other obvious signs)
History of progressive weakness or anaesthesia

Semi-urgent / category 2

Nerve root pain – specialist referral NOT generally required within first six weeks, provided resolving:

  • Unilateral leg pain worse than lower back
  • Radiates to foot or toes
  • Numbness and paraesthesia in same direction

Foot drop longstanding

Spinal Claudication

Canal stenosis - chronic

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED
– Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED
– Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
– Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED
– Phone: (03) 6166 6100  Fax: (03) 6173 0489 - Phone the Neurosurgery Registrar on call via Switch (03) 6166 8308 and/or send to RHH DEM

Urgent:

Urgent cases must be discussed with the Neurosurgery Registrar on call to obtain appropriate prioritisation and a referral faxed to (03) 6173 0491

We will endeavour to see these patients within four weeks, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment