Introduction to Spinal Services

The Centre for Spinal Studies and Surgery (CSSS) is based within the Queen’s Medical Centre of Nottingham University Hospitals (NUH) NHS Trust. NUH is a large university hospital trust, the regional Major Trauma Centre, and a tertiary referral unit for all aspects of complex spinal pathology.

The CSSS comprises the spinal ward (D8), our same-day emergency care unit (NSAU), specialist spinal theatres and the spinal outpatients department. All of our consultants exclusively perform spinal surgery and have a background in either orthopaedic surgery or neurosurgery.

As a multi-disciplinary team, the CSSS provides expert spinal care for rare and highly complex spinal conditions. Each of the spinal consultants has an area of special interest such as paediatric spinal deformity, adult spinal deformity, neuromuscular deformity, degenerative conditions of the spine, spinal oncology and primary bone tumours, spinal osteoporosis and spinal trauma.

Neuro-spinal assessment area (NSAU)

Neuro-spinal assessment area (NSAU) is the Spinal Same Day Emergency Care unit. It is an adult neurosurgery/neurology/spinal assessment area to help improve Emergency Department (ED) flow and reduce unnecessary admissions. The unit provides rapid-access, specialist triage for urgent and emergency presentations. The spinal component of NSAU is led by a Spinal Physiotherapy Consultant and includes highly experienced physiotherapists with advanced knowledge and skills in the assessment, diagnosis and treatment of spinal pain. Please read the attached leaflet (ST3 booklet v3.pdf [pdf] 444KB) for more information about what to expect if you attend NSAU (previously, ST3).

Outpatient Spinal Clinic

In these clinics we see patients with all manner of age-related conditions for consideration of spinal surgical management. Typically, patients are referred to see us by General Practitioners, Musculoskeletal (MSK) Triage services or other medical specialities following diagnostic imaging (MRI scans, X-Rays).

Patients will be seen by one of our Spinal Practitioner team who will take a detailed history, perform an in-depth examination and explain the results of any prior investigations in context. Via a shared decision making approach, the options for management will be discussed and the next steps agreed upon. This may well include further investigations, diagnostic injections, and referral to other specialities or discussion for spinal surgery with our Consultant Surgeon colleagues.

The most common conditions seen include;

  • Back and Leg symptoms due to nerve compression (Lumbar Radicular pain / Lumbar Stenosis)
  • Neck and Arm symptoms due to nerve or spinal cord compression (Cervical Radicular pain / Cervical Myelopathy)

Non-Medical Prescribing

Who are Non-medical prescribers?

In our team we have several individuals who can prescribe medication that are not doctors. They have achieved a separate qualification for this and their prescribing is overseen by their professional body, which has a code of standards. This has to be within their scope of practise, which in our case is mostly pain relief and its associated medications.

What is Non-medical prescribing?

Non-medical prescribing (NMP) is the term used to describe any prescribing completed by a healthcare professional other than a doctor or dentist.

How do they become NMP’s?

Suitable practitioners complete an appropriate programme from a university. Non-medical prescribing programmes provide the knowledge, skills and training to prescribe medication safely and competently.

The Royal Pharmaceutical Society has created a Prescribing Competency Framework for all prescribers that has been designed to help student education, maintain prescribing standards and give guidance for those involved in NMP.

Why don’t we just have doctors prescribe?

Non-medical prescribing (NMP) builds on the practitioners ability to care and treat their patients. This ultimately enhances patient care by giving patients’ quicker access to treatment with medicines, helping to decrease waiting times and reducing hospital admissions. So you can get the right medication, quicker and hopefully feel better sooner.


As a progressive, research-based spinal service, we provide spinal injections as per the GIRFT (Getting It Right First Time) Guidelines for lumbar radicular (nerve root) pain. Specifically, our practitioners are trained to perform nerve root blocks under X-ray guidance inclusive of L4-S1 region of the lumbar spine. As practitioners, we are an integral part of your clinical assessment, discussion of MRI imagery and treatment planning. We aim to inform the decision-making of all patients concerning the judicious use of spinal injections as both diagnostic and therapeutic tools. We are there to fully explain and discuss the indications to inject and any common risks/complications of the procedures as part of the consent process.

Following the injection, all patients are reviewed at 6-8 weeks post-procedure to discuss their current presentation, queries and assistance with ongoing clinical planning. As injecting practitioners, we undertake regular reviews with senior spinal/pain consultants to ensure clinical currency and competence and collect data to allow for service / individual review. This also enables us to share good practice between hospitals to assist in the ongoing development of practitioner-led spinal injections services across the NHS.


Young people that get referred to the spinal unit who have a spinal curvature (kyphosis, scoliosis and/or spinal pain) may see one of the Advanced Physiotherapy Practitioner (APP) team for their initial assessment and future conservative management.  During this clinic appointment the APP will seek information about the history, ask questions about any previous medical intervention and perform a physical examination.  Part of this assessment may also involve certain tests or diagnostic images such as an X ray or an MRI scan. 

For young people with a spinal curvature there is a possibility that the curve particularly during growth will become more exaggerated.  Monitoring for curve progression is achieved during a clinic follow up appointment where individuals will re- reassessed and further x rays taken at specific intervals.  In some circumstances a spinal curvature may require different forms of intervention such as physiotherapy and/or bracing.  This aims to halt the curve through growth.  Surgical intervention is also performed in some specific cases. 

The options and management for all individuals will be very specific to their presentation and is developed through a process of outcomes shared decision making and choice between the young person and their parent (s) / carer and the APP and surgeon.

Spinal & Advanced Practitioners

What is a spinal Advanced Physiotherapist Practitioner?

A spinal Advanced Physiotherapist Practitioner (APP) is a physiotherapist who has specialised in spinal assessment, management and care. 

Training includes post-graduate qualifications such as a Master’s degree and / or specialised training with the spinal surgical consultant team.  APPs are accountable to Health and Care Professions Council.  APPs are required to keep up to date with evidence-based practice, role specific competencies and to demonstrate their ongoing capability, usually in a portfolio format.

Why are you seeing a spinal Advanced Physiotherapist Practitioner?

As most people with spinal problems do not need surgery, guidance in the UK recommends that you are seen an APP for specialist assessment and further investigations if required.  APPs can request MRI, XRs, injections and bloods tests.

Contact spinal services

Centre for Spinal Studies and Surgery
D Floor, West Block
Queens Medical Centre
Derby Road

Switchboard: 0115 849 3367

  • ext 81005 - Bev Beeson
    (Speciality PA to Mr Tsegaye and Mr Shafafy)
  • ext 81024 - Rachael Blow
    (Waiting List Coordinator to Mr Patel)
  • ext 85484 - Chanice Burton
    (Speciality PA to Mr Quraishi & Mr Yoon)
  • ext 85160 - Shamell Cable
    (Speciality PA to Extended Scope Practitioners)
  • ext 81013 - Dr. Donna-Marie Urbanowicz
    (Speciality PA to Mr Salem, Mr D'Aquino, AOSpines & Fellows Co-Ordinator)
  • ext 85485 - Laura Hallam
    (Speciality PA to Mr. Patel, Mr. Paskou, Mr. Shah & Associate Spinal Specialists)
  • ext 82410 - Lynette Leek
    (Waiting List Coordinator to  Mr Salem & Mr D'Aquino)
  • ext 81273 - Angela Cocking
    (Waiting List Coordinator to Mr Quraishi & Mr Tsegaye)
  • ext 88469 - Christine Pickard
    (Waiting List Coordinator to Mr Shafafy & Mr Yoon)
  • Julie Russell-Laing - Support Secretary
  • Kelly Hoare - Support Secretary