Table 1. Red flags for potentially serious conditions

Possible fracture Possible tumor or infection Possible cauda equina syndrome
From medical history
Major trauma, such as vehicle accident or fall from height.

Minor trauma or even strenuous lifting (in older or potentially osteoporotic patient).
Age over 50 or under 20.

History of cancer.

Constitutional symptoms, such as recent fever or chills or unexplained weight loss.

Risk factors for spinal infection: recent bacterial infection (e.g., urinary tract infection); IV drug abuse; or immune suppression (from steroids, transplant, or HIV).

Pain that worsens when supine; severe nighttime pain.
Saddle anesthesia.

Recent onset of bladder dysfunction, such as urinary retention, increased frequency, or overflow incontinence.

Severe or progressive neurologic deficit in the lower extremity.

From physical examination
Unexpected laxity of the anal sphincter.

Perianal/perineal sensory loss.

Major motor weakness: quadriceps (knee extension weakness); ankle plantar flexors, evertors, and dorsiflexors (foot drop).

From: 14, Acute Low Back Problems in Adults: Assessment and Treatment

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