Red flag conditions and Cauda equina syndrome


Red flag conditions are rare. As they often lead to devastating neurological disability it is important to consider them and to refer for advice if there is any concern. The list includes spinal pain occurring in the following circumstances:

  • new onset back pain under the age of 20
  • new onset back pain over the age of 55
  • onset after major trauma (e.g. fall from height)
  • thoracic pain
  • history of malignancy
  • patients using systemic steroids
  • Immunocompromised patients (HIV, IVDA)
  • Patients who are systemically unwell / septic / raised ESR
  • Patients with unexplained weight loss
  • Patients with persistent severe restriction of lumbar flexion
  • Patients with known inflammatory conditions
  • Patient with widespread neurology
  • Patients with structural deformity
  • Patients with unremitting nocturnal pain

Cauda equina syndrome

This is a very rare but serious spinal condition that requires emergency surgical treatment (within 24 hours of onset). It includes:

  • bilateral radiating leg pain
  • sphincteric disturbance (insensate incontinence)
  • reduced perianal sensation
  • perineal numbness
  • progressive motor weakness affecting more than one nerve root and/or gait disturbances

Emergency referrals are made via the website. This should be followed up with a call to the on-call neurosurgical team on (01482) 875875 for advice on the emergency management.