Spinal APP within NHS Lothian - Lumbar spine pathway

Spinal APP within NHS Lothian - Lumbar spine pathway

STARTFINISHCreated with SnapReferral TriageSuitable for anassessment withinservice?STARTFINISHCreated with SnapPatient assessmentConsider differentialdiagnosis andpresence of red flagsSTARTFINISHCreated with SnapRed flags• High index of clinicalsuspicion of potentialserious lumbarpathology• See link for red flag...STARTFINISHCreated with SnapLeg symptomsSpine related legsymptoms. Includesradicular leg pain,radiculopathy, andneurogenic...YESNOSTARTFINISHCreated with SnapManagementIs Lumbar MRIindicated at thispoint?STARTFINISHCreated with SnapImaging...Consider Lumbar MRIindications(as per NMR protocol)STARTFINISHCreated with SnapCause not identifiedMild or nocorresponding neuralcompressionSTARTFINISHCreated with SnapClinical judgementConsider alternativediagnosis andmanagement optionsSTARTFINISHCreated with SnapCause identifiedModerate / severecorresponding neuralcompressionidentified +non-resolving severe...YESNOSTARTFINISHCreated with SnapPatient keen toconsiderinterventionaloptions?STARTFINISHCreated with SnapRefer neurosurgeryConsider:• Direct referral toNeurosurgeryor• Virtual Spinal Clinic...STARTFINISHCreated with SnapShared decision...STARTFINISHCreated with SnapSerious pathologyAction as per red flagpathwaySee NMR RadiologyProtocolSTARTFINISHCreated with SnapManagement/...Further investigationsor surgical opinion notrelevant at presentConservativemanagement /...STARTFINISHCreated with SnapNon-specific painSee link fornon-specific low backpain informationSTARTFINISHCreated with SnapManagementManagement andreferralconsiderationsSTARTFINISHCreated with SnapRe-route / Advice /...Based on servicecriteriaEnsure red flagsconsidered at the...