Spinal Injury, Back Pain & Neurological Red Flags
Separate routine back pain from trauma, infection and neurological compression emergencies.
Quick revision ↓ Medical Dictionary
01Traumatic spinal assessment
Use the major-trauma and spinal-injury pathway with appropriate movement restriction when indicated. Assess mechanism, pain, neurological findings and reliability of examination. Avoid assuming an alert patient has no spinal injury, and avoid unnecessary movement until the appropriate clearance process is completed.
02Neurological documentation
Record limb power and sensation, with additional examination appropriate to the suspected level and symptoms. New weakness, sensory change or sphincter disturbance requires prompt escalation. A normal limb radiograph does not address the spinal cord, and a limited examination must be clearly handed over.
03Cauda equina concern
New urinary retention or altered urinary sensation, saddle sensory change, bowel dysfunction or progressive bilateral neurological symptoms can suggest cauda equina compression. Seek emergency assessment through the spinal pathway. Do not wait for every feature or use one reassuring bedside finding to exclude the syndrome.
04Non-traumatic back pain
Most uncomplicated low back pain does not need routine imaging. Assess function and screen for features suggesting infection, malignancy, fracture or inflammatory disease. Support activity and appropriate conservative care when safe; imaging should answer a clinical question and be used when it may change management.
05Cancer and infection
Back pain with known cancer, systemic illness or neurological deterioration can signal metastatic compression or spinal infection. These need urgent specialist assessment and appropriate imaging. Treatment timing follows the relevant emergency pathway; routine physiotherapy referral is not an adequate response to evolving neurological compromise.
High-Yield Revision
- New sphincter or saddle symptoms require urgent assessment.
- Do not require every red flag before escalating.
- Routine imaging is not needed for every uncomplicated back pain.
Common Pitfalls
- Using a single normal finding to rule out cauda equina syndrome.
- Treating progressive neurological loss as ordinary mechanical pain.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.