Lumbar Screening - Red Flags

Question 1

How common is serious disease when someone has a presents with pain in lumbar region?

Answer 1

• Not very common

Question 2

Prescence of a single ____ is quite common

Answer 2

• red flag
• Use red flags in combination with clinical judgement

Question 3

What are the 8 red flags of the lumbar spine?

Answer 3

• Cancer/Tumor
• Cauda Equina
• Infection
• Fracture
• AAA
• Kidney Disease
• Ankylosing Spondylitis
• Failure to Progress

Question 4

Questions to screen for cancer

Answer 4

• Age over 50
• Personal Hx of Cancer
• Significant Unexplained weight loss (10% or more without trying)
• Do not get relief with laying down
• Failure of conservative treatment for 30 days

Question 5

Questions to screen Cauda Equina

Answer 5

Any changes with bowel or bladder control?
Any numbness or tingling in the genital region? (Saddle Anethesia)

Question 6

Questions to ask about infection

Answer 6

Are you otherwise generally healthy?
Any fevers?

Question 7

Questions to screen Fractures

Answer 7

Over the age of 50
Hx of Steroid use
Hx of trauma
Osteoporosis

Question 8

Questions to screen for AAA

Answer 8

• Cardiovascular Risk Factors (Smoking, Fam Hx, Male, Age over 50)
• Palpate or see an abdominal pulse

Question 9

Questions to screen for kidney disease

Answer 9

Any blood in your urine?
Any issues with urinating?
Are you generally healthy?

• Often present with unilateral flank or LBP
• Difficulty with initiating urination, painful urination, or blood in uring
• Recent Hx of UTI
• Past episodes of kidney stones
• Positive percussion over the kidney

Question 10

Signs of Ankylosing Spondylitis

Answer 10

• Insidious onet (late adolescence)
• Low back or SI
• Worse in the morning and worse with rest
• Don’t respond to Tx after 4 weeks
• More common in men
• Inflammatory Condition

Question 11

What is considered a failure to progress in Tx?

Answer 11

• 30 days without improvement is grounds for medical investigation

Question 12

When is imaging appropriate?

Answer 12

• Trauma, Osteoporosis, chronic steroid use, elderly individual (x-ray, CT, MRI)
• Suspicion of cancer, infection, cauda equina (MRI/CT)
• Progressive neuro symptoms or persistent Sx after 6 wks. PT (MRI/CT)