What are Red Flags?
Features, signs and symptoms in a patient with back pain which may indicate serious spinal pathology.
Features
- 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 corticosteroids
- Age greater than 70 years
- History of osteoporosis
- 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
