Lumbar Pain Red Flags

Question 1

What are the 5 types of serious pathology to screen for in a lumbar pain patient?

Answer 1

1. Infectious (osteomyelitis, tuberculosis, discitis, abscess)
2. Neoplasia
3. CVD (aortic dissection, retroperitoneal haemorrhage)
4. Neurological (cauda equina)
5. Fracture

Question 2

What are the red flags that indicate a potential cauda equina pathology?

Answer 2

1. Pain - severe localized LBP, may have sharp / stabbing pain in LL
2. Neurological - bilateral motor and sensory deficit in LL and saddle region
3. Systemic - bladder and bowel dysfunction, sexual dysfunction

Question 3

What are the red flags that could indicate a potential malignancy in a lumbar pain patient?

Answer 3

1. Pain - progressive, constant, unrelieved by rest or change in position, night pain
2. Systemic - fever, malaise, night sweats, unexplained weight loss, easily bruised, nausea / vomiting

Question 4

Which substances increase the risk of a fracture in a lumbar pain patient?

Answer 4

Corticosteroids, anti-coagulants, cocaine, amphetamines

Question 5

What are the red flags that could indicate a potential fracture in a lumbar pain patient?

Answer 5

1. Pain - acute midline back pain (note: may be painless in elderly patients with severe osteoperosis); aggravated by standing and sitting, relieved by lying down
2. Spinal change - loss of height, kyphotic / wedge shaped deformity of spine, spinal stiffness
3. Neurological - may have radiculopathy or myelopathy

Question 6

What are the red flags that could indicate a potential osteomyelitis pathology in a lumbar pain patient?

Answer 6

1. Systemic signs of infection - fever, sweats / chills, malaise, nausea / vomiting
2. Localized bone pain
3. Localized oedema over bone