Symptom distribution
Where the pain, paraesthesia and weakness sit, in dermatomal and myotomal terms if possible. C7 accounts for more than half of cervical radiculopathy and C6 for around a quarter, so a clear distribution often predicts the level.
Refer a patient
The mechanics of sending a cervical spine referral: where it goes, how long it stays valid, what to put in the letter, and what to tell the patient to bring. The clinical content that makes a cervical referral useful is set out on the referrer page.
The short version
Fax referrals to (07) 3236 9555, or the patient can bring the letter with them.
A GP referral is valid for twelve months; a specialist referral for three months.
Patients can send an enquiry through the website first and will be contacted within the next business day.
Send the images, not only the reports. Degenerative findings are near-universal and the report alone rarely settles anything.
Include graded power and reflexes. Cord signs and progressive weakness change the urgency, and neither shows on a scan.
Anything urgent is better phoned through than faxed. Acute cord compression belongs in an emergency department.
Fax
(07) 3236 9555
For referrals and correspondence from other practices.
Phone
(07) 3870 3708
Rooms direct, Monday to Friday, 8:30am to 4:30pm.
12 and 3
Months of validity for a GP referral and a specialist referral respectively.
Spring Hill
Watkins Medical Centre, Level 10, 225 Wickham Terrace, Spring Hill QLD 4000.
THE PROCESS
Four steps, none of them complicated
STEP 1
Write the referral
A standard specialist referral. The checklist below covers the cervical-specific content that saves a second appointment, most of which is clinical rather than administrative.
STEP 2
Send it, or give it to the patient
Fax to (07) 3236 9555, or have the patient bring it. Either works. Patients without a referral in hand can still send a website enquiry, and the office will contact them within the next business day.
STEP 3
Arrange the imaging access
Tell the patient to bring the actual X-rays and scans rather than only the reports, or to arrange portal access from the radiology practice. This is the single most common gap.
STEP 4
Flag anything urgent by phone
The practice notes that it cannot guarantee a timely response to urgent matters through the website form, and asks that urgent concerns be phoned through during business hours.
CHECKLIST
What to include in the letter
General guidance rather than a required format. Everything here exists to answer one question: does the imaging finding explain this patient's symptoms?
Onset, duration and trajectory
When it started, whether it is improving, static or worsening. Most acute radiculopathy resolves within eight to twelve weeks, so where the patient sits on that curve matters more than the severity on the day.
Graded power and reflexes
Objective findings rather than reported weakness. Include reflexes, Hoffmann's, clonus and gait if myelopathy is a consideration, because those findings change the pathway.
Treatment already tried
Which measures, for how long, and with what effect. Whether non-surgical treatment has had a fair go is frequently the decisive point in the consultation.
Imaging performed, and where
Modality, date and the practice that holds it, so the images can be retrieved if the patient arrives without them. Prior cervical surgery and any hardware are worth stating explicitly.
The usual background
Comorbidities, anticoagulation, smoking status and current medications. Smoking is particularly relevant if a fusion is likely to be discussed.
FOR THE PATIENT
What to tell them before they go
01
Bring four things
The referral, past and recent X-rays, scans and laboratory results, their Medicare and health fund cards, and a list of current medications.
02
Arrive 10 to 15 minutes early
The practice asks for that much time to complete the registration forms and a pain questionnaire before the appointment starts.
03
The images, not the reports
Worth saying twice to the patient. Most radiology practices provide a disc or portal access on request, and it needs organising before the day rather than on it.
04
Set the expectation
Most cervical problems are managed without an operation. A referral is for an opinion on what is causing the symptoms and what would help, not a decision that has already been made.
There is a patient-facing version of all of this on your first appointment, which you are welcome to point people to.
Send the images, not just the reports
Degenerative findings are near-universal on cervical imaging, so a written report rarely settles anything on its own. A referral carrying graded power, reflexes, gait and a clear symptom distribution, with the actual images available, answers the question that matters: does the finding explain this patient's symptoms?
COMMON QUESTIONS
Questions from referring practices
Where do I send it?
Fax (07) 3236 9555, or have the patient bring the letter. The rooms are at Watkins Medical Centre, Level 10, 225 Wickham Terrace, Spring Hill QLD 4000.
How long is a referral valid?
A referral from a general practitioner is valid for twelve months. One from a specialist is valid for three months. Medicare rebates require a valid Medicare card and a current referral.
Should I organise imaging first?
Where the clinical picture warrants it, MRI is the most useful single investigation for both radiculopathy and suspected myelopathy. Bear in mind the base rate of incidental findings, and that the images matter more than the report.
What about WorkCover, DVA or medico-legal?
The practice sees privately insured, uninsured, WorkCover, DVA, Defence, interstate, overseas and medico-legal patients. Note which applies on the referral so it can be set up correctly.
My patient lives a long way away.
Telehealth consultations are available to patients residing in Medicare-approved regions. A remote appointment covers the history and imaging well, but not the examination, which is a real limitation in suspected myelopathy.
NEXT
Related referrer pages
For referring doctors
What makes a cervical referral useful, which imaging answers which question, and the natural history that sets the timing.
Referrer information ›Urgent referrals and red flags
Cord signs, the mJOA severity bands and the presentations that belong in an emergency department.
Red flags ›Your first appointment
A patient-facing page on what to bring, when to arrive and what a cervical assessment involves.
What to expect ›About this information
The contact details, referral validity, arrival time and enquiry response statements are as published by the practice. The referral checklist is general guidance for referring practitioners rather than a required format or a protocol. More about Dr Tollesson.
References
Cervical Radiculopathy, StatPearls, National Library of Medicine, for the distribution of affected levels and the natural history of acute nerve root pain.
A Clinical Practice Guideline for the Management of Degenerative Cervical Myelopathy, AO Spine and the Cervical Spine Research Society, for the signs that warrant escalation.
Fax (07) 3236 9555. Anything urgent, phone instead.
Rooms direct on (07) 3870 3708, Monday to Friday, 8:30am to 4:30pm.