Lumbar Red and Yellow Flags

Age

• less than 20 years

• over 50 years (malignancy)

• over 70 years (fx)

• previous history of

• constitutional sx

• failure to improve with

• recent urinary

• previous history of cancer

• constitutional sx

  • fever, chills, unexplained weight loss

• failure to improve with conservative care (usually over 4 to 6 weeks)

• recent urinary tract infection, blood in urine (or stools), difficulty with urination

• history of _____ use

• immunocompromised condition

• pain is not relieved by

• severe, constant ____ ____

• progressive …

• history of drug use

  • can introduce an infection that can spread to the spine

• immunocompromised condition

  • prolonged use of corticosteroids, transplant recipient, autoimmune diseases

• pain is not relieved by rest or recumbency

• severe, constant night pain

• progressive neurologic deficit; saddle anaesthesia; urinary or fecal incontinence

• back pain accompanied by

• history of

• significant morning

• skin

• back pain accompanied by abdominal, pelvic, or hip pain

• history of falls or trauma (screen for fx, osteoporosis, domestic violence, alcohol use)

• significant morning stiffness with limitation in all spinal movements (ankylosing spondylitis or other inflammatory disorder)

• skin rash (inflammatory disorder [Crohn’s disease, ankylosing spondylitis])

Red Flags that may ↑ likelihood of Cancer:

• Hx of CA​

• Night pain or pain at rest​

• Unexplained weight loss​

• Age > 50 yrs. old OR < 17 yrs. old​

• Failure to improve over the predicted time interval following Rx

Undiagnosed Vertebral Fx:

• Prolonged use of corticosteroids​

• Mild trauma > 50 yrs. Old​

• Age > 70 yrs. Old​

• A known Hx of osteoporosis​

• Recent major trauma at any age (MVA or fall > 5 ft.)

Infection within Disc (discitis) or Vertebrae (osteomyelitis):

• The patient is immunosuppressed​

• A prolonged fever with temp > 100.4◦F​

• Hx. of intravenous drug abuse​

• Hx. of a recent UTI, cellulitis, or pneumonia

Abdominal Aortic Aneurysm:

• A pulsating mass in the abdomen​

• A history of atherosclerotic vascular disease​

  • high blood pressure

• A throbbing, pulsing back pain at rest or with recumbency​

  • especially when lying down

• Age > 60 yrs. old

yellow flags

• Patient's personal mistaken belief about pain​

  • Emotional distress ​

    • Depression​

    • Anxiety​

  • Pain catastrophizing​

    • Excessive pre-occupation with pain​

  • Elevated fear-avoidance beliefs​

    • Benign activities can harm spine  measured with the FABQ