Neck pain associated with neurological deficit/Cervical Myelopathy

Availability

North South North West Statewide

Pre-referral work-up

History

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

  • Presence and duration of neurological symptoms and signs including evidence of lower limb spasticity
  • Work status
  • Weight loss, appetite loss and lethargy
  • Fever and sweats
  • Treatment to date
  • Previous malignant disease
  • General medical condition
  • Height, weight and BMI

Tests

Investigations (only if indicated):

  • Plain X-ray – flexion/extension
  • FBC/CRP & ESR
  • Consider calcium and phosphate, protein
  • electrophoresis, immunoglobulins, PSA
  • Rheumatoid serology in specific cases
  • MRI – CT

Interim/GP management

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

  • Pharmacological management
  • Physiotherapy
  • Contact Registrar on-call for advice

For more information please see the Tasmanian Health Pathways website.

Emergency

Spinal trauma including spinal cord compression with severe or rapidly progressive deficit

Spinal fracture (unstable or suspected unstable) or with neurological deficit

Urgent / category 1

Flexion and flexion – rotation injury compression fractures (consider increasing symptomology)

Semi-urgent / category 2

Recent onset >6/52 of symptoms

Routine / category 3

Patients with no referred arm pain or neurological deficit and unremarkable imaging are not routinely seen

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