Lumbar Spine Red Flags

• Red flag:

  • Possible indicator of serious pathology
  • serious pathology - fracture, cancer, infection, caudal equine syndrome, inflammatory disorder
• Subjective examinations - provides clearer indications of serious pathology than objective:

  • aggravators/eases
  • 24 hr pattern
  • history of presenting condition
  • past medical history
  • family history
  • social history
  • body chart
  • special questions
• Hierarchy of subjective red flags includes:

  • age (< 10, 11 - 19, > 51)
  • past medical history (cancer, TB, HIV and AIDS, injected drug use, osteoporosis)
  • general health (smoking)
  • weight loss (< 5% body weight, 5 - 10% body weight, > 10% body weight)
  • Cauda equina symptoms
  • Systematically unwell
  • Trauma
  • VBI’s S+S
  • Bilateral P&N in hands and/or feet
  • Previous failed treatment
  • Constant progressive pain
  • Thoracic spinal pain
  • Abdominal pain and changed bowel habits not related to medication
  • Severe night pain
  • Headache
• Hierarchy of objective red flags includes:

  • Physical appearance
  • Inability to lie supine
  • Bizarre neurological deficit
  • Marked restrictions of movement
  • Loss of sphincter tone and altered S4 sensation
  • Vertebral artery testing
  • Upper cervical spinal instability tests
  • Positive plantar response
  • Disturbed gait
• Bilateral pins and needles:

  • Not a definite indicator of spinal cord compression
  • Usually complain of:
  • A feeling of walking on cotton wool
  • Loss of dexterity
  • Diffuse non-specific weakness
  • Altered sensation
  • Broad based jerky gait
• Constant progressive pain:

  • Non-mechanical
  • No change with pain killers and NSAIDs
  • 24 hour pattern