Red Flags (lumbar spine)

Question 1

what do red flags suggest

Answer 1

serious underlying pathology such as tumour, infection or spondylolisthesis

Question 2

what are some red flag symptoms

Answer 2

• back pain in under 20’s
• new back pain in over 60’s
• nature of pain is constant, severe, worse at night
• systemic upset

Question 3

why is under 20’s a red flag

Answer 3

• uncommon
• younger patients susceptible to infections
• adolescents are at peak age for spondylolisthesis as well as some benign and malignant bone tumours

Question 4

why is new back pain in over 60’s a red flag

Answer 4

• arthritic change
• crush fracture
• higher risk of neoplasia, metastatic change and multiple myeloma

Question 5

why is constant, severe pain worse at night a red flag

Answer 5

mechanical pain is typically improved on rest, pain from tumours or infections tend to be consent, unremitting, severe and worse at night

Question 6

what is included in systemic upset

Answer 6

fever, night sweats, weight loss, fatigue and malaise

Question 7

what does systemic upset suggest

Answer 7

underlying tumour or infection

Question 8

what investigations does infection or tumour require

Answer 8

history, exam, bloods (CRP, FBC, U&E’s, bone biochemistry, plasma protein electrophoresis, PSA in males), blood culture if infection is suspected, spinal x-ray, bone scan, MRI

Question 9

what could x-ray show

Answer 9

vertebral collapse or loss of a pedicle on AP view