Low Back Red Flags

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