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BACKPAIN/REDFLAGSSciatica (Cancer (> 50 YOA, Gradual onset of symptoms.…
BACKPAIN/REDFLAGSSciatica
Spinal fracture
Sudden
onset of severe central spinal pain
relieved
by lying down.
There may be a history of major
trauma
or even just strenuous lifting in people with
osteoporosis
or use of
corticosteroids
.
Structural deformity
of the spine (such as a step from one vertebra to an adjacent vertebra) may be present.
point tenderness
over a vertebral body.
Cancer
> 50
YOA
Gradual
onset of symptoms.
Severe unremitting pain
that
remains
when
supine
,
aching night pain
,
pain aggravated by straining
(for example, at stool, or when coughing or sneezing), and
thoracic pain.
Localised
spinal tenderness.
Persists
>6/52
after conservative low back pain therapy.
Unexplained
weight loss
.
Past history of cancer
— breast, lung, gastrointestinal, prostate, renal, and thyroid cancers are more likely to metastasize to the spine.
Infection
(such as discitis, vertebral osteomyelitis, or spinal epidural abscess)
Fever
Tuberculosis, or recent urinary tract infection.
Diabetes.
History of intravenous drug use.
HIV infection
immunocompromised
.
Cauda equina syndrome
Severe or progressive bilateral neurological deficit of the legs, such as major motor weakness with knee extension, ankle eversion, or foot dorsiflexion.
Difficulty initiating micturition or impaired sensation of urinary flow, if untreated this may lead to irreversible
Urinary retention with overflow urinary incontinence
Loss of sensation of rectal fullness, if untreated this may lead to irreversible
Faecal incontinence
Perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia).
Laxity of the anal sphincter.
CKS
Sciatica (lumbar radiculopathy)
