Mr Simon Cudlip is a consultant neurosurgeon and spinal surgeon based in Oxford in the United Kingdom
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Back Pain Information from SpineUniverse
Which Patients Should You Refer To
a Neurosurgeon?
Neurosurgeons are able to treat a wide array of patients with problems ranging from brain tumours to degenerative spinal disorders and peripheral nerve compression. Generally, if you suspect that there is a disorder of the brain or spine which may require a surgical opinion then referral to a local neurosurgeon would be appropriate.
There is considerable overlap between the clinical conditions encountered by orthopaedic surgeons, neurosurgeons and neurologists. Generally, once these patients are assessed and investigated by any one of these specialists they can be referred on to the appropriate specialist within the ORH trust if this is required.
If patients have questions about driving there is upto date information on the DVLA website
Below are some guidelines on the urgency of referral of some common neurosurgical conditions
What Constitutes a Neurosurgical Emergency?
The conditions listed below are a guide, if you have any concerns about a patient then you can either talk to the Neurosurgical registrar on call at the John Radcliffe Hospital (Tel 01865 741166), or the Consultant on call available via the John Radcliffe Hspital switchboard.
1. Patients that should go to A&E in the first instance
Alteration in level of consciousness
Sudden neurological deficit with altered level of consciousness
Sudden onset headache with suspicion of intracranial haemorrhage
New cranial nerve palsy, especially painful oculomotor nerve palsy
Gradual onset neurological deficit such as hemiparesis
Symptoms of raised intracranial pressure
Any suggestion of CSF shunt malfunction
Suggestion of Cauda Equina Syndrome*
2. Patients that need an urgent referral
If in doubt about the urgency of a referral please contact the neurosurgical SpR on call at the Radcliffe Infirmary Oxford (Tel 01865 741166). Otherwise a fax is best either addressed to the Neurosurgical consultant on call, or a consultant of your choice (Fax 01865 224898).
My secretary Abby Mason can be contacted on Tel 01865 224549, fax 01865 224898 or email Abby.Mason@orh.nhs.uk
Once the details are taken, or the fax received, the urgency of the case will be assessed and the patient booked into the next available clinic (usually within 7 days), or arrangements will be made for the patient to be seen urgently as an outpatient in the department of Neurosurgery at the John Radcliffe Hospital.
Cases that would be appropriate urgent referrals include:
New foot-drop with or without sciatica
Severe back pain and sciatica unresponsive to conventional measures
New weakness or numbness in an upper limb
Severe nocturnal back pain
Thoracic myelopathy
Progressive cervical myelopathy
3. Patients that can be referred routinely
These referrals are best made by letter and / or fax, or choose and book. In some cases patients will be prioritised based upon the need to investigate / treat more urgently and be seen sooner than this.
Back pain unresponsive to conventional measures
Back pain and sciatica
Neurogenic claudication due to spinal stenosis
Neck pain unresponsive to conventional measures
Neck pain and cervical radiculopathy
Carpal tunnel syndrome / ulnar neuropathy
*Cauda Equina Syndrome
This clinical syndrome can be very difficult to diagnose. The cardinal symptoms are back pain, sciatica (often bilateral), and disturbance of the perineal or pericoccygeal sensation. In association with this may be weakness of numbness of the legs and / or feet with absent ankle reflexes, and rarely knee reflexes.
Urinary symptoms can be difficult to interpret in a patient in severe pain who has also taken analgesics causing constipation. Features that are red flag symptoms include urinary and faecal incontinence and painless distension of the bladder. If a patient complains of urinary symptoms, then often a useful question is whether they feel more comfortable after emptying their bladder ie they have intact bladder sensation.
If you have a patient in whom you suspect cauda equina syndrome but are not sure then the safest option is to refer via your local A&E where a more formal assessment can be made, and imaging organised if appropriate. If the MRI scan shows cauda equina compression I would almost always operate the same day.
Neurosurgeons are able to treat a wide array of patients with problems ranging from brain tumours to degenerative spinal disorders and peripheral nerve compression. Generally, if you suspect that there is a disorder of the brain or spine which may require a surgical opinion then referral to a local neurosurgeon would be appropriate.
There is considerable overlap between the clinical conditions encountered by orthopaedic surgeons, neurosurgeons and neurologists. Generally, once these patients are assessed and investigated by any one of these specialists they can be referred on to the appropriate specialist within the ORH trust if this is required.
If patients have questions about driving there is upto date information on the DVLA website
Below are some guidelines on the urgency of referral of some common neurosurgical conditions
What Constitutes a Neurosurgical Emergency?
The conditions listed below are a guide, if you have any concerns about a patient then you can either talk to the Neurosurgical registrar on call at the John Radcliffe Hospital (Tel 01865 741166), or the Consultant on call available via the John Radcliffe Hspital switchboard.
1. Patients that should go to A&E in the first instance
Alteration in level of consciousness
Sudden neurological deficit with altered level of consciousness
Sudden onset headache with suspicion of intracranial haemorrhage
New cranial nerve palsy, especially painful oculomotor nerve palsy
Gradual onset neurological deficit such as hemiparesis
Symptoms of raised intracranial pressure
Any suggestion of CSF shunt malfunction
Suggestion of Cauda Equina Syndrome*
2. Patients that need an urgent referral
If in doubt about the urgency of a referral please contact the neurosurgical SpR on call at the Radcliffe Infirmary Oxford (Tel 01865 741166). Otherwise a fax is best either addressed to the Neurosurgical consultant on call, or a consultant of your choice (Fax 01865 224898).
My secretary Abby Mason can be contacted on Tel 01865 224549, fax 01865 224898 or email Abby.Mason@orh.nhs.uk
Once the details are taken, or the fax received, the urgency of the case will be assessed and the patient booked into the next available clinic (usually within 7 days), or arrangements will be made for the patient to be seen urgently as an outpatient in the department of Neurosurgery at the John Radcliffe Hospital.
Cases that would be appropriate urgent referrals include:
New foot-drop with or without sciatica
Severe back pain and sciatica unresponsive to conventional measures
New weakness or numbness in an upper limb
Severe nocturnal back pain
Thoracic myelopathy
Progressive cervical myelopathy
3. Patients that can be referred routinely
These referrals are best made by letter and / or fax, or choose and book. In some cases patients will be prioritised based upon the need to investigate / treat more urgently and be seen sooner than this.
Back pain unresponsive to conventional measures
Back pain and sciatica
Neurogenic claudication due to spinal stenosis
Neck pain unresponsive to conventional measures
Neck pain and cervical radiculopathy
Carpal tunnel syndrome / ulnar neuropathy
*Cauda Equina Syndrome
This clinical syndrome can be very difficult to diagnose. The cardinal symptoms are back pain, sciatica (often bilateral), and disturbance of the perineal or pericoccygeal sensation. In association with this may be weakness of numbness of the legs and / or feet with absent ankle reflexes, and rarely knee reflexes.
Urinary symptoms can be difficult to interpret in a patient in severe pain who has also taken analgesics causing constipation. Features that are red flag symptoms include urinary and faecal incontinence and painless distension of the bladder. If a patient complains of urinary symptoms, then often a useful question is whether they feel more comfortable after emptying their bladder ie they have intact bladder sensation.
If you have a patient in whom you suspect cauda equina syndrome but are not sure then the safest option is to refer via your local A&E where a more formal assessment can be made, and imaging organised if appropriate. If the MRI scan shows cauda equina compression I would almost always operate the same day.