RED FLAG MARKERS

Consider prompt investigation or specialist referral (less than 4 weeks) for anyone with a red flag for possible spinal pathology, namely:

• Presentation under 20 years
• First presentation over 55 years
• Violent trauma (e.g. road traffic accident)
• Nonmechanical pain
• Thoracic pain
• Past history of carcinoma
• Corticosteroid use
• HIV infection
• Systemically unwell, weight loss
• Widespread neurological symptoms or signs
• Structural deformity

Immediate admission is needed for cauda equina syndrome:

• Sphincter disturbances
• Saddle anaesthesia
• Widespread or progressive motor weakness in the legs
• Gait disturbance