COVID-19: Spinal/Neurosurgery service guide

May 2020

Scope

This information provides guidance on the management of Spinal/Neurosurgery patients across Western locality during the COVID-19 pandemic.

National guidance

Urgent advice/Emergency conditions

Please call the on-call Neurosurgery registrar via UHP Switchboard telephone: 01752 202082

The following serious pathologies must be dealt with on the day as an emergency:
  • Cauda equina syndrome (CES): People presenting with spinal and leg pain, with neurological symptoms and any suggestion of changes in bladder or bowel function or saddle sensory disturbance, should be suspected of having CES
  • Metastatic spinal cord compression (MSCC): MSCC occurs as a consequence of metastatic bone disease in the spine. It can lead to irreversible neurological damage. Symptoms can include spine pain with band-like referral, escalating pain and gait disturbance
  • Spinal Infection: May present with spinal pain, fever and worsening neurological symptoms. Consider risk factors (e.g. immunosuppressed, primary source of infection, personal or family history of tuberculosis)
  • Spinal fracture (traumatic or pathological)

2WW referrals

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

Urgent referrals

Consider serious pathology as a differential diagnosis if a person presents:
  • with escalating pain and progressively worsening symptoms that do not respond to conservative management or medication as expected
  • systemically unwell (fever, weight loss)
  • with night pain that prevents sleep due to escalating pain and/or difficulty lying flat.
  • Myelopathy
    • Injury to the spinal cord due to compression of the cord itself
    • Symptoms include loss of sensation, loss of function and pain at or below the compression point
  • Hydrocephalus / BIH / Arnold Chiari Malformation
    • Symptoms include headache, vomiting, blurred vision, difficulty walking, irritability and sleepiness
  • Neurovascular (cerebral aneurysm/AVM)
    • refer to Neurovascular MDT
  • Radiculopathy with severe pain / neurologic deficit
    • Radiculopathy is pinching of the nerve roots as they exit the spinal cord or cross the intervertebral disc (rather than compression of the cord itself – myelopathy)
  • Axial pain secondary to Spondylolithesis with associated neurological deficit
    • Spondylolithesis is forward slippage of a vertebra
  • Spine pain related to vertebral collapse with neurologic deficit

Referral via DRSS and then clinical triage by consultants/ spinal team – usual process applies.

Routine referrals

All 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 appropriate clinical referral guidance on the Fomulary and Referral website has been reviewed and that all the suggested investigations and management options have been considered.

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate.

  • Spine pain related to vertebral collapse without neurological deficit
  • Radiculopathy without severe pain / neurological deficit
  • Axial pain secondary to Spondylolithesis with no associated neurological deficit
    • Refer urgently if patient develops neurological deficit
  • Lumbar stenosis
  • Brachalgia
  • Scoliosis

Advice & Guidance

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

COVID-19 High risk patient advice

Social distancing and based on the national risk stratification grid of medication and comorbidities. Clinical review undertaken and advice given.

Western Spinal/ Neurosurgery contact information

  • On-call Neurosurgery registrar via UHP Switchboard on telephone: 01752 202082

Pathway Group

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

Last updated: 12-05-2020

 

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