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Figure 1
Diagnostic Triage including 'Red Flags'
SIMPLE BACKACHE
Presentation between ages 20-55
Lumbosacral region, buttocks and thighs
Pain "mechanical" in nature
varies with physical activity
varies with time
Patient well
Prognosis good
90% recover from acute attack in six weeks
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NERVE ROOT PAIN
Unilateral leg pain worse than low back pain
Pain generally radiates to foot or toes
Numbness and paraesthesia in the same distribution
Nerve irritation signs
reduced SLR which reproduces leg pain
Motor, sensory or reflex change
limited to one nerve root
Prognosis reasonable
50% recover from acute attack within six weeks
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RED FLAGS for Possible Serious Spinal Pathology
Presentation under age 20 or onset over the age of 55.
Violent Trauma: eg fall from a height, RTA
Constant, progressive, non-mechanical pain
Thoracic pain
PMH - Carcinoma
Systemic steroids
Drug abuse, HIV
Systemically unwell
Weight loss
Persisting severe restriction of lumbar flexion
Widespread neurological signs and symptoms
Structural deformity
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CAUDA EQUINA SYNDROME/WIDESPREAD NEUROLOGICAL DISORDER
Difficulty with micturition
Loss of anal sphincter tone or faecal incontinence
Saddle anaesthesia about the anus, perineum or genitals
Widespread (>one nerve root) or progressive motor weakness in the legs or gait disturbance
Sensory level
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INFLAMMATORY DISORDERS (Ankylosing spondylitis and related disorders)
Gradual onset before age 40
Marked morning stiffness
Persisting limitation spinal movements in all directions
Peripheral joint involvement
Iritis, skin rashes (psoriasis), colitis, urethral discharge
Family history
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