AdulLs wlLh < 3 monLhs of acLlvlLy lnLolerance because

of low back paln and/or back-relaLed leg sympLoms

CbLaln focused medlcal hlsLory and physlcal examlnaLlon (lncludlng
neurologlc screenlng and sLralghL leg ralslng Lo search for red flags"
lndlcaLlng posslble splnal ln[ury).
8ed flags presenL?
?es
8ed flags for cancer or lnfecLlon
CbLaln C8C, LS8, and uA

lf cancer or lnfecLlon ls sLlll suspecLed,
conslder consulLaLlon or seek furLher
evldence wlLh bone scan, radlography, or
addlLlonal laboraLory LesLs. (noLe LhaL a
negaLlve radlograph alone does noL rule
ouL dlsease. lf poslLlve, deflne Lhe
anaLomy wlLh M8l.)
Lvldence of serlous dlsease?
?es
no
ln Lhe absence of red flags, dlagnosLlc
LesLlng ls noL cllnlcally helpful ln Lhe flrsL
four weeks of sympLoms
8ed flags for splnal fracLure 8ed flags for cauda equlna
syndrome or rapldly progresslng
neurologlc deflclL
CbLaln plaln-fllm
radlograph of
lumbosacral splne.

lf, afLer 10 days, fracLure
ls sLlll suspecLed or
paLlenL has mulLlple slLes
of paln, conslder bone
scannlng and consulLaLlon
before deflnlng anaLomy
wlLh C1 scannlng.
CbLaln lmmedlaLe
consulLaLlon for emergency
sLudles and deflnlLlve care.
no
Arrange approprlaLe LreaLmenL
or consulLaLlon
?es
Lvldence of nonsplnal
medlcal problem causlng
referred back problems?
no
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llCu8L 1. lnlLlal assessmenL of paLlenL wlLh acuLe low back paln problems. (C1 = compuLed Lomography, C8C = compleLe blood counL, LS8 = eryLhrocyLe
sedlmenLaLlon raLe, uA = urlnalysls, M8l = magneLlc resonance lmaglng)
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