Serious pathology in the absence of an obvious cause (eg trauma) is very rare, but be aware of signs suggestive of more serious pathology.
Symptoms suggestive of cauda equina syndrome (compression of the cauda equina):
Significant symptoms that may suggest cancer:
Other symptoms that may suggest cancer include:
Symptoms that may suggest infection:
Symptoms that suggest fracture:
Red flags may also be indicated by:
NB: Be aware that some red flags have very high false-positive rates and as such have little diagnostic value in primary caresettings. Careful clinical judgment to decide whether to investigate further or refer is needed.
Patients with any of the following suspected should be sent to A&E:
Consider urgent referral to Consultant Spinal Surgeon Clinic (where certain of malignancy contact Oncology):
Urgent referral to Rheumatology Clinics for suspected spondyloarthropathy:
Consider diagnosis (discuss within peer review)
Consider features of radiculopathy:
Undertake bio-psychosocial assessment.
Early management as per acute back pain (and leg pain) pathway
Specific symptoms that indicate need to secondary care referral:
No referrals to secondary care orthopaedics unless:
Individual Funding Requests
Certain spinal procedures are listed on Gloucestershire CCG's Effective Clinical Commissioning Policy. Please the attached link for details of access criteria and funding arrangements.