Emergency Low Back Pain

This condition is treated in the Neurosurgery clinic.

Pre-referral work-up

History

Emergency lower back pain conditions should be referred directly to the Emergency Department for immediate assessment and care. In the North and North-West, please contact the Emergency Department Medical Officer in Charge. In the South, please call the Neurosurgery Registrar on call to advise of the presenting patient and relevant history.

See list of Emergency low back pain conditions below.

Non-emergency lower back pain conditions should have exhausted non-operative management options (including physiotherapy) before referring for specialist assessment.

In the South, patients with non-emergency lower back pain with or without lower limb neurological signs and symptoms requiring specialist assessment and management, including surgical opinion, should be referred to the Back Assessment Clinic.

In the North and North-West, patients with non-emergency lower back pain, with or without neurological signs and symptoms, requiring specialist assessment and management, including surgical opinion, should be referred to the State-wide Neurosurgery Service.

All referrals should comply with the referral standards and specifically include:

• 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 there is suspicion of red flags or symptoms persist despite an adequate trial of conservative management:

• Plain X-rays and CT or MRI (MRI preferable if available)
• FBC/CRP/ESR
• LFT, U&E, CR

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.

Consider referral to Community Physiotherapy before referral to Back Assessment Clinic (Southern patients only).

Simple analgesia including paracetamol and NSAIDs should be trialled.

Advice re: weight loss and suitable exercise to maintain mobility should be offered.

For more information please see the HealthPathways Tasmania website.

Clinic appointments

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

Emergency

Red Flags

? Acute Cauda Equina Syndrome (back pain with bladder/bowel dysfunction/saddle paraesthesia)
? Severe / rapidly progressing neurological deficits including acute foot drop
? Cord signs or symptoms including gait abnormalities and/or hyperreflexia 
? Infective spinal disorder
? Spinal fracture with evolving neurological deficit
? Unstable spinal fracture

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

• Risk of irreversible deficit if not seen within 1-4 weeks
• Spinal tumours (benign or malignant)
• Stable spinal fractures without evolving neurological deficit

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 30 days, or sooner if clinically indicated.

Semi-urgent (Category 2)

We will endeavour to see these patients within 90 days, or sooner if clinically indicated.

Routine (Category 3)

Next available appointment. We will endeavour to see these patients within 365 days.

Availability

North

All referrals and queries are to be directed to:

Launceston General Hospital
Phone: 03 6166 0000
Fax: 03 6234 9941

North West

All referrals and queries are to be directed to:

North West Regional Hospital
Phone: 03 6166 0000
Fax: 03 6234 9941

South

All referrals and queries are to be directed to:

Liverpool Clinics (Level 7)
Phone: 03 6166 0000
Fax: 03 6234 9941