Primary care clinician within NHS Lothian - Lumbar spine red flags
MSK pathways
Red Flags
Red flags are signs and symptoms which are found in the patient history and clinical examination that may tie a disorder to a serious pathology. In general, red flags may warrant further diagnostic workup and potentially immediate onward referral to a spinal specialist service. Their use is recommended in numerous national and international guidelines. Incidence of serious pathology in patients with back pain in primary care is around 1%.
Suspected cauda equina syndrome
Call Flow Navigation Centre on 03000 134000
Acute foot drop
Discuss with On call Neurosurgical registrar via switchboard 0131 242 1000
Deteriorating lumbar radiculopathy with motor deficit grade 3 or less (Oxford scale)
Discuss with On call Neurosurgical registrar via switchboard 0131 242 1000
Suspected vertebral fragility fractures
- Consider key risk factors, physical findings & importance of identifying.
- See specific information on associated VFF Pathway.
Suspected metastatic spine cord compression (MSCC)
Immediately follow MSCC pathway if patient has cancer (or strongly suspected) or is under follow up from a previous cancer and one of the following:
- Severe, intractable progressive pain, especially thoracic
- New spinal nerve root pain (burning numb, shooting)
- Any new difficulty walking
- Reduced power/ altered sensation in limbs
- Bowel/ bladder disturbance.
Lothian Metastatic Spinal Cord Compression Pathway - Available at: MSCC Intranet Page
A pathway of care for patients with suspected metastatic spinal cord compression with the aim of ensuring optimal co-ordination and early investigation.
Please Note: Separate documents available for NHS Lothian & NHS West Lothian - Please select appropriate depending on work area.
Suspected infection
Discuss with On call Neurosurgical registrar via switchboard 0131 242 1000
Suspected malignancy
If clinical assessment by GP leads to a very strong suspicion of suspected underlying malignancy, consider recommendations and referral options detailed here
Suspected vascular symptoms
Clinical features of Intermittent Claudication see guidance on Intermittent Claudication RefHelp page
Clinical features of Abdominal Aortic Anneurysm see guidance on Abdominal Aortic Aneurysm RefHelp page
Widespread Neurology - features not in keeping with lumbar radiculopathy
See Neurology refhelp pages for further referral guidance and support.
Presence of other significant red flags
- Suspicion of potential serious pathology, not linked to conditions above, but of clinical concern
- Refer urgently to relevant speciality.