RED FLAGS Flashcards
What are the red flags you should be aware of for the lumbar spine?
1) Cancer
2) Cauda Equina Syndrome
3) Spinal Compression Fracture
4) Spinal Infection
5) Abdominal Aortic Aneurysm
What are the symptoms/characteristics that would make you think CANCER?
1) history of cancer
2) failure to improve with 30 days of conservative management
3) unexplained weight loss
4) constant pain not improved with position or activity
5) age over 50 years
** 2 or 3 of these should be positive to refer out to MD
Which symptom/characteristic for CANCER has the largest likelihood ratio?
History of cancer
What symptoms/characteristics are most suggestive of CANCER?
1) unexplained weight loss
2) failure to improve within 30 days of conservative management
3) age over 50
What is the gold standard for a cancer diagnosis?
MRI
What ESR levels would indicate cancer?
ESR>20 increases suspicion of cancer
ESR>50 has a high positive likelihood ratio for cancer
What types of cancers are most likely to metastasize to the spine?
Breast
Kidney
Lung
Thyroid
Prostate
(Big Kids Like To Party)
What are the symptoms that would lead you to suspect Cauda Equina Syndrome?
bowel and bladder changes
saddle anesthesia
sensory + motor deficits in L4, L5, S1
urinary retention
Is incontinence or urinary retention a more likely red flag for cauda equina syndrome?
Inability to urinate or completely empty the bladder is the most sensitive and specific sign
If you suspect cauda equina syndrome what should you do?
Refer to the ED
What characteristics are indicative of a Spinal Compression Fracture?
Hx of a major trauma (MVA, fall, direct blow to spine)
Age>50 , Age>75 has an even high risk
Prolonged use of steroids
Point tenderness over the side of fracture
Increased pain with weight bearing, thoracic pain (70% of non-traumatic occur in the T-spine)
hx of osteoporosis + hx of spinal fractures
trauma is an even greater risk factor if it involves spinal flexion
Females = higher risk
What characteristics would lead you to suspect Spinal Infection?
recent infection
IV drug user
immunosuppressive disorder
constant pain that increases with WBing
fever, malaise, swelling *most useful
spine rigidity
local tenderness over spinal process with percussion
What is the classic triad for spinal infection?
back pain, fever, neurological dysfunction
What characteristics would lead you to suspect an Abdominal Aortic Aneurysm?
back, abdominal, or groin pain
presence of PVD, CAD, CVS risk factors
smoking
family history of AAA
age >70
non-caucasian
females
sxs not associated with movement stress (throbbing LBP)
presence of a bruit in central epigastric area upon auscultation
palpation of aortic pulse
When is imaging recommended?
Only for severe neurological deficits or red flags suspected
