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CITATION ABSTRACT:Introduction: We present a unique pathway for care aimed specifically at spinal patients. As a result of the shift of the spoke direction from the existing hub-and-spoke model, patient care is being redirected successfully with great benefit to a rural department. Within the rural community, it is the spoke that is the main locality to which patients present and at which they are treated. Subspecialty procurement is often more central and located in tertiary referral centres outside of a rural position. This in itself can prove difficult to patients and their relatives because subspecialty treatment, when required, is often only accessed at tertiary referral centers, which can present travel difficulties to patients and their relatives. This is at a time of great vulnerability for patients and families when what is required is more stability and familiarity.

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