COVID-19: Spinal service guide

May 2020

Scope

This information provides guidance on the management of Spinal patients from Northern, Eastern and Southern Areas of Devon during the Covid-19 pandemic. The information is based on guidance from the Spinal Team at the Royal Devon and Exeter Hospital

National guidance

Clinical guide for the management of patients requiring spinal surgery during the Coronavirus pandemic

Specialty guides for patient management during the coronavirus pandemic: Urgent and Emergency Musculoskeletal Conditions Requiring Onward Referral

2 Week Wait

Brain tumours / 2WW (including pituitary, intradural spinal and skull base lesions)

Referral via 2WW pathway as usual: Anyone suspected of having a brain or spinal tumour should have urgent structural imaging organised and positive findings referred directly to the neurosurgical MDT

Emergency

The presence of 2 or more Red flags significantly raises the likelihood of serious spinal pathology. Please refer to the STarT back Red flags:

Send to ED if suspicion of:
  • Cauda Equina Syndrome (CES)
  • Spinal infection (history of immunosuppression, intravenous drug user (IVDU), fever, blood test sepsis, recent bacterial infection)
Refer URGENTLY to Spinal TEAM at RD&E via ED:
  • in presence of deteriorating neurology (consider upper and lower motor neurone signs)
  • in cases of suspected cancer

Refer via the Spinal On call team via switchboard tel: 01392 411611

Urgent referrals

The RD&E Team are running HOT CLINICS for urgent problems
  • Patients will be telephoned initially
  • Then booked to see either ESP or Consultant in a hot/trauma clinic Monday/Wednesday/Friday
  • Conditions:
    • Cauda Equina Syndrome
    • Severe Myelopathy
    • Deteriorating neurology
    • High suspicion of cancer
    • Infection
    • Wound problems
    • Severe+++ radicular pain
High Risk Patients
  • Patients will be telephoned and seen with priority when the service re-opens
  • Referral kept in the office for a further telephone call in less than 3/12
  • Conditions:
    • Cancer history but NOT presenting with any other red flags
    • Mild/mod Symptoms of myelopathy without myelomalacia (if scanned)

Referral via DRSS and then clinical triaged by the Spinal Team – usual process applies.

Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Low Risk
  • Spine pain related to vertebral collapse without neurological deficit
  • Radiculopathy without severe pain / neurological deficit
  • Refer urgently if pain becomes severe and/or patient develops neurological deficit
  • Axial pain secondary to Spondylolithesis with no associated neurological deficit
  • Refer urgently if patient develops neurological deficit
  • Lumbar Stenosis
  • Brachalgia
  • Scoliosis

Existing new and follow up routine appointment have been cancelled and changed to telephone consultations where appropriate.

Advice & Guidance

Please refer patients via DRSS – these referrals will be processed as usual with clinical advice and guidance given at triage.

Supporting information

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 07-05-2020

 

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