Spine education

Red Flags for Serious Spinal Pathology

When assessing a patient with spinal or limb pain, it is important to look for the presence of red flags, which may indicate serious underlying spinal pathology. If a serious condition is suspected, an urgent or emergency referral to your local spinal unit may be necessary, although a degree of clinical judgement is required when referring these cases.

Red Flags for Spinal Metastases

  • Constant severe mechanical spinal pain
  • Progressive spinal pain despite conservative treatment.
  • Persistent thoracic spine pain.
  • Patient age under 20 or over 50 with back pain for the first time.
  • Personal or family history of cancer.
  • Unexplained weight loss, cachexia, loss of apetite.
  • Structural deformity of spine.

Red Flags for Spinal Infection

  • Constant severe spinal pain which continues when supine. May worsen at night.
  • Unexplained fever, malaise or lethargy.
  • Recent bacteraemic infection, UTI, or endoscopic procedure.
  • Immune suppression risk factors: Diabetes, alcohol dependence, IV drug misuse or HIV.
  • Structural deformity of spine.

Red Flags for Cauda Equina Syndrome

  • Recent onset urinary retention with overflow incontinence.
  • Recent onset faecal incontinence
  • Bilateral sciatica, leg numbness or weakness
  • Progressive bilateral neurological deficit in the legs
  • Perineal / saddle anaesthesia
  • Lax anal sphincter

Red Flags for Spinal Fracture

  • History of fall or spinal trauma.
  • History of osteoporosis
  • Long-term steroid medication.

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