Red flags in back pain 

Features, signs and symptoms in a patient with back pain which indicate serious spinal pathology.

History

  • Previous history malignancy.
  • Age 16< or >50 with NEW onset pain.
  • Weight loss (unexplained).
  • Previous longstanding steroid use. 
  • Recent serious illness.
  • Recent significant infection.

Symptoms 

  • Non-mechanical pain (worse at rest) 
  • Thoracic pain
  • Fevers/ rigors 
  • General malaise 
  • Urinary retention 

Signs 

  • Saddle anaesthesia 
  • reduced anal tone 
  • hip or knee weakness 
  • generalised neurological deficit 
  • progressive spinal deformity 
  • urinary retention 


investigations if not referring ASAP

  • Myeloma screen.
  • ESR, CRP, FBC, U+E, Calcium. PSA if suggestive.
  • Plain xray.
  • Consider MRI