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)
Undertake bio-psychosocial assessment and management.
In the absence of radiculopathy initial management (follow acute back pain pathway).
Spondylolisthesis Grades II ( 50% and above) with intrusive pain and disability consider referral via interface team.
Initial management consider self-refer or referral to Physiotherapy.
Where unresolved a severe persistentpainfulsymptoms consider referral to Interface Team.
If not responding consider guidelines above and appropriate referral to Interface Team.
Consider referral to Surgeon if fits criteria.
No referrals to secondary care 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.