People with LBP with suspicion of spinal infection or cauda equina syndrome should be immediately referred to a neurosurgeon or an emergency department.
TOP 2015. Toward Optimised Practice - Evidence-Informed Primary Care Management of Low Back Pain: Clinical Practice Guidelines. 3rd Edition. December 2015. Institute of Health Economics, Alberta, Canada.
Schedule an urgent appointment with a physician if any of the red flags are present.
Agency for Healthcare Research and Quality / National Guidelines Clearinghouse 2012. Low back pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Available at: http://www.guideline.gov/
DIFFERENTIAL DIAGNOSIS: Clinicians should consider diagnostic classifications associated with serious medical conditions or psychosocial factors and initiate referral to the appropriate medical practitioner when (1) the patient’s clinical findings are suggestive of serious medical or psychological pathology, (2) the reported activity limitations or impairments of body function and structure are not consistent with those presented in the diagnosis/classification section of these guidelines, or (3) the patient’s symptoms are not resolving with interventions aimed at normalization of the patient’s impairments of body function.
Refer patient with red flags indicating a high likelihood of serious underlying pathology for immediate evaluation and treatment to an appropriate resource depending on what is available in your region (e.g., emergency room, relevant specialist). The presence of Cauda Equina Syndrome is considered to be a surgical emergency.
Bardin, L.D., King, P. and Maher, C.G., 2017. Diagnostic triage for low back pain: a practical approach for primary care. The Medical Journal of Australia, 206(6), pp.268-273.