Defined as multi-level degenerative change to bones, disc, ligaments and joints considered to be largely age related rather than specific other diagnosis - includes Spinal Stenosis and Neurogenic Claudication.
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 spinal stenosis:
Undertake bio-psychosocial assessment:
If not responding consider referral to Interface Team.
If patient fits criteria consider referral to Pain Clinic / Pain Medicine.
Consider referral where:
AND optimal analgesia.
No referrals to secondary care orthopaedics unless: