Red Flags for Serious Spinal Pathology

When assessing a patient with spinal or limb pain, it is important to look for the presence of red flags, which may indicate serious underlying spinal pathology. If a serious condition is suspected, an urgent or emergency referral to your local spinal unit may be necessary, although a degree of clinical judgement is required when referring these cases.

Red Flags for Spinal Metastases

  • Constant severe mechanical spinal pain
  • Progressive spinal pain despite conservative treatment
  • Persistent thoracic spine pain
  • Patient age under 20 or over 50 with back pain for the first time
  • Personal or family history of cancer
  • Unexplained weight loss, cachexia, loss of appetite
  • Structural deformity of spine

Red Flags for Spinal Infection

  • Constant severe spinal pain which continues when supine. May worsen at night
  • Unexplained fever, malaise or lethargy
  • Recent bacteraemic infection, UTI, or endoscopic procedure
  • Immune suppression risk factors: Diabetes, alcohol dependence, IV drug misuse or HIV
  • Structural deformity of spine

Red Flags for Cauda Equina Syndrome

  • Recent onset urinary retention with overflow incontinence
  • Recent onset faecal incontinence
  • Bilateral sciatica, leg numbness or weakness
  • Progressive bilateral neurological deficit in the legs
  • Perineal / saddle anaesthesia
  • Lax anal sphincter

Red Flags for Spinal Fracture

  • History of fall or spinal trauma
  • History of osteoporosis
  • Long-term steroid medication



Bristol Spine Clinic
Nuffield Health Bristol
3 Clifton Hill,

Mr Patel is available at the Nuffield Health Hospital in Bristol, however, we treat patients from across the South West including Cheltenham, Gloucester, Hereford, Worcester, Wiltshire, Somerset and South Wales.

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