Lumbar Red Flags

Why is it important to evaluate the whole picture of someone w/ acute LBP?

most pts w/ acute LBP have at least 1 red flag

What are the risk factors for spinal fractures or stress fractures?

• high speed trauma

• age >75

• minor trauma after age 50

• traumatic adolescent lumbar hyperextension activities

What are the red flags or needs referral for lumbar pathology?

• cauda equina syndrome

• lumbar fx/stress fx

• back tumor

• back infection (TB, discitis, spinal abscesses) or osteomyelitis

• cervical myelopathy (if UMN lesion)

• abdominal/aortic aneurysm

• axial spondyloarthritis or inflammatory back pain

• spinal instability (spondylolysis & spondylolisthesis)

• visceral referral

• MS, ALS

• DVT

• vascular claudication

What are the risk factors for back tumors?

• age >50

• hx of cancer

• fail to improve in 30 days

• unexplained weight loss

• no relief w/ rest

What are some questions to ask a pt w/ urogenital referred pain patterns?

• pain or difficulty urinating?

• blood in urine?

• incontinence, frequent urination, ∆ in volume?

• impotence?

• irregular menstruation? post-menopausal bleeding?

• painful intercourse?

• recent infections?

What are some questions to ask a pt w/ GI referred pain patterns?

• difficulty swallowing?

• nausea/heartburn/indigestion?

• vomiting?

• pain after eating esp. fatty foods?

• ∆s in appetite?

• constipation/diarrhea?

• ∆s in stool color? rectal bleeding?

• ∆s in bowel patterns?

How would you describe non-MSK red flags?

• Sx's increase w/ rest

• Sx's not associated w/ movement

• Sx's more systemic in nature

• diffuse Sx's

• Sx's migrate from one joint to another

• pt hx of serious illness, cancer, or unexpected weight loss

What are some questions you can ask a pt when suspecting cauda equina syndrome?

• any numbness & tingling in the saddle area?

• any bowel or bladder problems?

• any severe weakness on both legs?

• any sensation loss in the feet?

What are the risk factors for back infections (TB, discitis, spinal abscesses) or osteomyelitis?

• recent infection (UTI, cellulitis, pneumonia)

• immunosuppressed

• fever

• abuse

• recent surgery

What are the risk factors for abdominal or aortic aneurysm?

• hx of PVD or CAD

• hx of smoking

• HTN

• diabetes

• age >50

• throbbing pulsating pain in back, abs, or groin

• abnormal width of aortic pulse, bruit w/ auscultation

What are the risk factors for spondyloarthritis or inflammatory back pain?

• gene HLA-B27

• males aged 15-30

• duration >3 months

• insidious onset

• morning stiffness >30 min

• improves w/ exercises, worsens w/ rest

• awakening at night d/t pain esp. during 2nd half

• alternating butt pain (sacroilitis)