According to the American Association of Neurosurgical Surgeons, just about every adult in America will suffer from back pain including pulled muscles, degenerative disease and trauma. These patients are often first seen by a primary care physician, so it is important to realize key points in diagnosis treatment and referral.
During the initial assessment of the patient, it is critical to rule out potentially serious conditions including: spinal tumors, fractures, infection, cauda equina syndrome, and spinal osteomyelitis. Red flags that require immediate attention include:
Patients exhibiting a combination or a single red flag without any obvious medical reason should have prompt evaluation and aggressive treatment.
If there is evidence of an initial red flag, an appropriate referral should be made immediately. Patients should also be referred for a surgical consult if they meet the following criteria:
Great toe extensor weakness
Impaired ankle reflux
|Pain at < 60 degrees indicates compromise
Absence of pain strongly indicates no compromise
Absence of weakness indicates no nerve root compromise
Weakness indicates possible compromise at L5-S1
Poor reflex indicates possible compromise at L5-S1
Decreased sensation indicates no L5-S1 weakness compromise
Absence of weakness indicates no L4 compromise