What are Red Flags?Features, signs and symptoms in a patient with back pain which may indicate serious spinal pathology.
Previous malignancy Age <16 or >50 with new onset of pain Unexpained weight loss Longstanding steroid use Recent infection Signs & Symptoms
Saddle anaesthesia Reduced anal tone Generalised neurological deficit Progressive spinal deformity Urinary retention Non-mechanical pain that is worse at rest Thoracic pain Fevers/rigors General malaise
Cancer
Low back pain History of cancer Unexplained weight loss >10 kg within 6 months Age over 50 years or under 17 years old Failure to improve with therapy Pain persists for more than 4 to 6 weeks Night pain or pain at rest
Infection
Low back pain Persistent fever History of intravenous Drug Abuse Severe Pain Lumbar spine surgery within the last year Recent bacterial infection (e.g. UTI, cellulitis or pneumonia) Immunocompromised states (e.g. HIV, transplant or diabetes)
Cauda Equina Syndrome
Back Pain Urinary incontinence or retention Saddle anesthesia Anal sphincter tone decreased or fecal incontinence Bilateral lower extremity weakness or numbness Progressive neurologic deficit
Major motor weakness Major sensory deficit
Erectile dysfunction
Cord Compression
Low back pain Leg weakness Limb numbness Ataxia Urinary retention Hyper-reflexia Extensor plantars Clonus
Vertebral Fracture
Low back pain Prolonged use of c orticosteroid s Age greater than 70 years History of o steoporosis Mild trauma aged over 50 (or with osteoporosis) Recent significant trauma at any age
AAA (Abdominal Aortic Aneurysm)
Low back pain Abdominal pulsating mass Atherosclerotic vascular disease Pain at rest or nocturnal pain Age greater than 60 years
