Assessment of atraumatic back and spine conditions in children

Specialty: Children's Orthopaedic
Age group: Children

Criteria for referral to public hospital service

• Severe or progressive low back pain that has persisted for longer than 6 weeks with functional impairment or sleep disturbance, that has been unresponsive to medical management
• Symptomatic spondylolysis or spondylolisthesis with more than 50 percent slippage in a child younger than 16 years
• Kyphosis
  • thoracic kyphosis greater than 60 degrees
  • kyphosis of the lumbar spine
  • short or sharp kyphosis with any underlying congenital spinal anomaly
  • in a child younger than 18 years with associated underlying conditions (e.g. neurofibromatosis, achondroplasia)
• Scoliosis in a child
  • younger than 13 years with Cobb angle greater than 10 degrees
  • 13 to 17 years with Cobb angle greater than 20 degrees
  • younger than 18 years with associated underlying conditions (e.g. neuromuscular conditions, chromosomal or genetic abnormality).

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the child, or their carer, and the referring clinician from referral to the health service
• Findings on physical examination. For scoliosis include any
  • shoulder, trunk, or waist asymmetry
  • rib or lumbar asymmetry on forward bend
  • leg length discrepancy
• The functional or psychological impact on quality of life or activities of daily living including impact on work, study, social activities or carer role
• Pain history: onset, location, nature of pain and duration
• Details of previous management and pain management including the course of treatment(s) and outcome of treatment(s)
• Child’s age
• Relevant medical history and comorbidities
• For kyphosis and scoliosis weight bearing/standing front and lateral EOS scan of the spine. If EOS scan is not available, weight bearing/standing views x-ray of complete spine: posteroanterior (PA) and lateral views (including details of the diagnostic imaging practice)
• For back pain, spondylolysis or spondylolisthesis weight bearing/standing views x-ray of complete spine: posteroanterior (PA) and lateral views (Including details of the diagnostic imaging practice).

Provide if available

• Any other recent relevant imaging
• Statement about the parent(s) or guardian’s interest in having surgical treatment if that is a possible intervention
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child is neurodiverse, gender diverse or has a disability
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If the child is aged 14 to 18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

It is preferable to get an EOS scan rather than x-ray as this will have reduced radiation for the patient.

The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.

Note there are adult statewide referral criteria for Ankylosing spondylitis (inflammatory back pain).

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Back pain without radiologic abnormality or radicular symptoms
• Spondylolisthesis with less than or equal to 50 percent slippage
• Thoracic kyphosis less than or equal to 60 degrees
• Cobb angle less than or equal to 10 degrees.