Joy.

Red flags

Beware cognitive bias...

cauda equina syndrome:
- bilateral sciatic/radicular pain
- bladder/bowel symptoms
- See page for full list of symptoms
Traumatic spinal fractures
- major trauma
- point tenderness over single vertebral body
- sudden onset severe central spinal pain relieved by lying down
Non-traumatic spinal fractures
- classically fragility fractures - compression fractures
- consider bone metastases, multiple myeloma
Bony metastases
- age >50
- Severe persistent lumbar pain;
- thoracic back pain;
- night spinal pain preventing sleep
- spinal pain aggravated by straining/coughing/sneezing/defaecation
- localised spinal tenderness
- MRI preferred
infection - Discitis, epidural abscess
- risk factors: DM, IVDU, previous HIV infection

Discharge advice

Continue daily activities as soon as possible
But off work until can walk/perform emergency stop → then discuss with work re adjusted duties (heavy lifting, etc.)
Multimodal analgesia
- "the goal is to be able to walk to the toilet and back"...
Adaptations
Most back pain resolves within 6-8 weeks

NICE NG59 1.1.4: Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica. [2016]
Early imaging associated with higher intervention rates, worse outcomes
Role is more for planning interventions e.g. surgery
MRI findings are common in asymptomatic people