II. Precautions

  1. Low back red flag check lists have poor Test Specificity
    1. Many patients with Low Back Pain have at least one red flag (>80%)
  2. Evaluate red flags in the context of the clinical presentation as a whole
    1. Keep a high index of suspicion in high risk patients or where more than one red flag is present

III. Red Flags: Cancer Related Red Flags with Low Back Pain

  1. History of cancer
  2. Unexplained weight loss >10 kg within 6 months
  3. Age over 50 years or under 18 years old
  4. Failure to improve with therapy
  5. Pain persists for more than 4 to 6 weeks
  6. Night pain or pain at rest

IV. Red Flags: Infection Related Red Flags with Low Back Pain

  1. Persistent fever (Temperature over 100.4 F)
    1. Poor Test Sensitivity for Spinal Infection
  2. History of intravenous Drug Abuse
  3. Severe Pain
  4. Lumbar spine surgery within the last year
  5. Recent bacterial infection
    1. Urinary Tract Infection or Pyelonephritis
    2. Cellulitis
    3. Pneumonia
    4. Wound (e.g. Decubitus Ulcer) in spine region
  6. Immunocompromised states
    1. Systemic Corticosteroids
    2. Organ transplant
    3. Diabetes Mellitus
    4. Human Immunodeficiency Virus (HIV)
    5. Rest Pain

V. Red Flags: Cauda Equina Syndrome Related Red Flags with Back Pain

  1. Urinary Incontinence or retention
  2. Saddle anesthesia
  3. Anal sphincter tone decreased or Fecal Incontinence
  4. Bilateral lower extremity weakness or numbness
  5. Progressive neurologic deficit
    1. Major motor weakness
    2. Major sensory deficit

VI. Red Flags: Significant Herniated nucleus pulposus

  1. Major Muscle Weakness (strength 3 of 5 or less)
  2. Foot drop

VII. Red Flags: Vertebral Fracture related red flags with Low Back Pain

  1. Prolonged use of Corticosteroids
  2. Age greater than 70 years
  3. History of Osteoporosis
  4. Mild trauma over age 50 years (or with Osteoporosis)
  5. Recent significant trauma at any age
    1. Ejection from motor vehicle
    2. Fall from substantial height

VIII. Red Flags: Abdominal Aortic Aneurysm red flags with Low Back Pain

  1. Abdominal pulsating mass
  2. Atherosclerotic vascular disease
  3. Pain at rest or nocturnal pain
  4. Age greater than 60 years

IX. Red Flags: General (weak Test Specificity)

  1. Vertebral tenderness
  2. Limited spine range of motion

Images: Related links to external sites (from Google)

Ontology: Low Back Pain (C0024031)

Definition (MSH) Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous SPRAINS AND STRAINS; INTERVERTEBRAL DISK DISPLACEMENT; and other conditions.
Definition (AOT) see:http://www.nlm.nih.gov/mesh/MBrowser.html
Concepts Sign or Symptom (T184)
MSH D017116
ICD9 724.2
ICD10 M54.5
SnomedCT 156648004, 40709005, 279039007, 202793005, 156651006, 268083007, 139421003, 267169009
English Back Pain, Low, Back Pains, Low, Low Back Pains, Lumbago, Low Back Ache, Low Backache, Lower Back Pain, Ache, Low Back, Aches, Low Back, Back Ache, Low, Back Aches, Low, Back Pain, Lower, Back Pains, Lower, Backache, Low, Backaches, Low, Low Back Aches, Low Backaches, Lower Back Pains, Pain, Lower Back, Pains, Lower Back, BACK PAIN, LOWER, LOW BACK PAIN, LUMBAGO, LUMBAR PAIN, Pain, Low Back, Pains, Low Back, Nonspecific pain lumbar region, Low back derangement syndrome, Lower back pain, Lumbago syndrome, low back pain (symptom), lower back pain, lumbago (diagnosis), lumbar back pain, lumbar pain, lumbago, low back pain, lbp, Lumbago (disorder), LBP, Low back ache, BACK PAIN LOWER BACK, BACK PAIN LUMBAR, Lumbago NOS, Low Back Pain [Disease/Finding], lumbalgia, Pain;back low, Pain;back;lumbar, low backache, low back pains, lower back pains, lumbar pains, Low back pain, Low back syndrome, Lumbalgia, LBP - Low back pain, Nonspecific pain in the lumbar region, Lumbar pain, back; pain, low, backache; low, low back; pain, low; backache, pain; back, low, pain; low back, syndrome; low back, LBP - low back pain, Lumbago (disorder) [Ambiguous], Low back pain (finding), Low back pain (disorder), Low Back Pain
Portuguese DOR LOMBAR, Moinha lombar, Dor lombar, Dor Lombar, Lombalgia, Lumbago
Dutch lumbago, pijn in de onderrug, lage rugpijn, lumbaalpijn, laag; rugpijn, lage rug; pijn, pijn; lage rug, pijn; onderste deel van rug, pijn; rug, laag, rug; pijn, laag, rugpijn; laag, syndroom; lage rug, Lage rugpijn, Lagerugpijn, Lumbago, Pijn, lagerug-
French Endolorissement de la région lombaire, Douleur dans la partie inférieure du dos, Douleur lombosacrale, DOULEUR LOMBAIRE, Douleur dorsale basse, Douleur lombaire basse, Douleur du bas du dos, Rachialgie lombo-sacrale, Rachialgie lombo-sacrée, Rachialgie lombosacrale, Rachialgie lombosacrée, Rachialgie lombaire, Lombalgie, Lumbago, Douleur lombaire, Douleur lombosacrée
German unterer Rueckenschmerz, unterer Rueckenschmerzen, lumbaler Schmerz, Kreuzschmerz, SCHMERZ LENDENGEGEND, Kreuzschmerzen, Lumbago, Lumbalsyndrom, Hexenschuß
Italian Dolore dorso-lombare, Lombalgia, Lombaggine, Dolore lombare
Spanish Dolor de la parte baja de la espalda, Dolor lumbar, dolor de espalda, LBP - low back pain, Lumbalgia, Low back pain, Lumbar pain, LBP - Low back pain, Lumbago, LUMBAR, DOLOR, dolor inespecífico en la región lumbar, dolor lumbar, lumbago, lumbalgia (concepto no activo), lumbalgia (hallazgo), lumbalgia (trastorno), lumbalgia, síndrome de dolor en la región inferior de la espalda, Dolor de la Región Lumbar, Dolor de la Region Lumbar
Swedish Ländryggssmärta
Japanese ヨウツウショウ, ヨウツウ, 腰痛, 腰痛症
Czech lumbalgie, bolest v kříži, lumbago, Bolest dolní poloviny zad, Bederní bolest, Lumbago, ústřel
Finnish Alaselkäkipu
Russian RADIKULIT POIASNICHNYI, LIUMBAGO, POIASNICHNYI RADIKULIT, ЛЮМБАГО, ПОЯСНИЧНЫЙ РАДИКУЛИТ, РАДИКУЛИТ ПОЯСНИЧНЫЙ
Korean 아래허리통증
Croatian LUMBOSAKRALGIJA
Polish Ból krzyża, Ból dolnego odcinka kręgosłupa, Lumbago, Ból okolicy lędźwiowo-krzyżowej
Hungarian Lumbago, Alsó háti fájdalom, derékfájás, Derékfájdalom, Lumbalis fájdalom

Ontology: Aortic Aneurysm, Abdominal (C0162871)

Definition (NCI) Enlargement and ballooning of the vessel that supplies arterial blood to the abdomen, pelvis and legs.
Definition (MSH) An abnormal balloon- or sac-like dilatation in the wall of the ABDOMINAL AORTA which gives rise to the visceral, the parietal, and the terminal (iliac) branches below the aortic hiatus at the diaphragm.
Concepts Disease or Syndrome (T047)
MSH D017544
SnomedCT 155422008, 233985008
English ANEURYSM, AORTA, ABDOMINAL, Aortic Aneurysm, Abdominal, Abdominal Aortic Aneurysms, Aneurysm, Abdominal Aortic, Aneurysms, Abdominal Aortic, Aortic Aneurysms, Abdominal, AAA-Abdominal aortic aneurysm, ABDOMINAL AORTIC ANEURYSM, ANEURYSM, ABDOMINAL AORTIC, Abdominal Aortic Aneurysm, AAA (abdominal aorta aneurysm), aaa, aneurysm of abdominal aorta, aneurysm of abdominal aorta (diagnosis), Abdominal aneurysm, Aneurysm of abdominal aorta, AORTA ABDOMINAL ANEURYSM, abdominal aorta aneurysm, abdominal aortic aneurysm, AAA (abdominal aortic aneurysm), AAA, Aortic Aneurysm, Abdominal [Disease/Finding], Aneurysm;abdominal aortic, abdominal aneurysm, abdominal aortic aneurysms, abdominal aneurysms, aneurysm abdominal, abdominal aortic aneurysm (AAA), AAA - Abdominal aortic aneurysm, Abdominal aortic aneurysm, Abdominal aortic aneurysm (disorder), abdominal; aneurysm, aneurysm; abdominal aorta, aneurysm; abdominal, aorta abdominalis; aneurysm
Dutch abdominaal aneurysma, aneurysma van aorta abdominalis, aneurysma aorta abdominalis, abdominaal; aneurysma, aneurysma; abdominaal, aneurysma; aorta abdominalis, aorta abdominalis; aneurysma, Aneurysma aortae abdominalis
French Anévrysme abdominal, AAA (Anévrisme de l'Aorte Abdominale), Anévrisme aortique abdominal, Anévrysme aortique abdominal, Anévrisme de l'aorte abdominale, Anévrysme de l'aorte abdominale, Anévrisme abdominal aortique, Anévrismes abdominaux aortiques, Anévrysme abdominal aortique, Anévrysmes abdominaux aortiques
German Aneurysma der Bauchaorta, Aneurysma, Aorta, abdominales, Aortenaneurysma, abdominales, Aneurysma, Bauchaorten-, Bauchaortenaneurysma
Italian Aneurisma dell'aorta addominale, Aneurisma addominale, Aneurisma aortico addominale
Portuguese Aneurisma abdominal, Aneurisma da aorta abdominal, Aneurisma da Aorta Abdominal
Spanish Aneurisma de la aorta abdominal, Aneurisma aórtico abdominal, Aneurisma abdominal, Abdominal aortic aneurysm, Aneurisma de la Aorta Abdominal, Aneurisma de Aorta Abdominal, Aneurisma Aórtico Abdominal, Aneurisma Aortico Abdominal, aneurisma de aorta abdominal (trastorno), aneurisma de aorta abdominal
Swedish Aortabråck, buk
Japanese フクブダイドウミャクリュウ, 大動脈瘤-腹部, 腹大動脈瘤, 腹部大動脈瘤
Czech aorta abdominalis - aneurysma, Aneurysma břišní aorty, Břišní aneurysma
Finnish Vatsa-aortan aneurysma
Russian ANEVRIZMA AORTY BRIUSHNOI, AORTY BRIUSHNOI ANEVRIZMA, АНЕВРИЗМА АОРТЫ БРЮШНОЙ, АОРТЫ БРЮШНОЙ АНЕВРИЗМА
Polish Tętniak aorty brzusznej
Croatian AORTNA ANEURIZMA, ABDOMINALNA
Hungarian Hasi aorta aneurysma, Aorta abdominalis aneurysmája, Abdominalis aneurysma

Ontology: Fracture of lumbar spine (C0262544)

Definition (NCI) A fracture of one of the lumbar vertebra.
Concepts Injury or Poisoning (T037)
ICD10 S32.0
SnomedCT 207987002, 125608002
English LUMBAR SPINE FRACTURE, Fracture of lumbar spine NOS, fractures lumbar vertebra, fracture lumbar spine, Fracture;lumbar, fractures lumbar spine, fracture lumbar, lumbar fracture, lumbar vertebra fracture, fracture lumbar vertebra, fractures lumbar, Lumbar vertebral fracture, Fracture of lumbar spine, Fracture of lumbar vertebra, Fracture of lumbar spine (disorder), fracture; lumbar spine, fracture; spine or vertebra, lumbar, lumbar; spine, fracture, spine or vertebra; fracture, lumbar, Lumbar Vertebral Fracture, fracture of lumbar spine
Italian Frattura di vertebra lombare
Japanese 腰椎骨折, ヨウツイコッセツ
Spanish Fracture of lumbar spine, fractura de la columna vertebral lumbar (trastorno), fractura de la columna vertebral lumbar, fractura de las vértebras lumbares, Fractura de la vértebra lumbar
Czech Zlomenina bederního obratle
Korean 허리뼈의 골절
Hungarian Lumbalis csigolyatörés
Dutch fractuur; lumbale wervelkolom, fractuur; wervel{kolom}, lumbaal, lumbaal; wervelkolom, fractuur, wervel{kolom}; fractuur, lumbaal, Fractuur van lumbale wervel, lendenwervelbreuk
Portuguese Fractura da vertebra lombar
French Fracture de vertèbre lombaire
German Fraktur eines Lendenwirbels

Ontology: Cauda Equina Syndrome (C0392548)

Concepts Disease or Syndrome (T047)
MSH D011128
ICD9 344.6
ICD10 G83.4
SnomedCT 89356000, 192973005, 192970008, 155032006, 192972000
English CAUDA EQUINA SYNDROME, Cauda equina syndrome, NOS, Cauda equina syndrome NOS, cauda equina syndrome, cauda equina syndrome (diagnosis), Cauda Equina Syndromes, Syndrome, Cauda Equina, Syndromes, Cauda Equina, Cauda equina syndrome NOS (disorder), cauda equinas syndrome, lumbosacral syndrome, syndrome cauda equina, Lumbosacral syndrome, Cauda equina syndrome, Cauda equina syndrome (disorder), cauda equina; syndrome, syndrome; cauda equina, Cauda equina syndrome (disorder) [Ambiguous], Cauda Equina Syndrome
Italian Cauda Equina, Sindrome lombo-sacrale
Dutch lumbosacraal syndroom, cauda equina; syndroom, syndroom; cauda equina, cauda equina syndroom, Cauda-equinasyndroom
French Syndrome lombosacré, Syndrome de la queue de cheval
German Lumbosakralsyndrom, Cauda-equina-Syndrom, Cauda- (equina-) Syndrom, Cauda equina Syndrome
Portuguese Síndrome lombossagrada, Síndrome da Cauda Equina, Síndrome da cauda equina
Spanish Síndrome lumbosacro, Cauda equina syndrome, Síndrome de Cauda Equina, Sindrome de Cauda Equina, síndrome de la cauda equina, SAI, síndrome de la cauda equina, síndrome de la cola de caballo (concepto no activo), síndrome de la cola de caballo (trastorno), síndrome de la cola de caballo, SAI (trastorno), síndrome de la cola de caballo, SAI, síndrome de la cola de caballo, Síndrome de cauda equina
Japanese 馬尾症候群, 腰仙部症候群, ヨウセンブショウコウグン, バビショウコウグン
Czech Syndrom cauda equina, Lumbosakrální syndrom
Korean 말총증후군
Hungarian Cauda equina syndroma, Lumbosacralis syndroma

Ontology: Infection of lumbar spine (C0410372)

Concepts Disease or Syndrome (T047)
SnomedCT 203219002
English Infection of lumbar spine, Infection of lumbar spine (disorder)
Spanish infección de la columna vertebral lumbar (trastorno), infección de la columna vertebral lumbar

Ontology: Secondary malignant neoplasm of vertebral column (C0684550)

Definition (NCI) The spread of the cancer to the spine. This may be from a primary spinal cancer, or from a cancer at a distant site.
Concepts Neoplastic Process (T191)
SnomedCT 94602001
Italian Metastasi alla colonna vertebrale, Metastasi vertebrali
English Metastatic Neoplasm to the Spine, Metastatic Malignant Neoplasm to the Spine, vertebral metastasis (diagnosis), vertebral metastasis, Metastatic malignant neoplasm to vertebral column, NOS, Secondary malignant neoplasm of vertebral column, NOS, Metastatic malignant neoplasm to spine, NOS, Secondary malignant neoplasm of spine, NOS, Metastases to spine, Spinal secondaries, metastasis to spine, spine metastases, metastasis spine, spine metastasis, spinal metastases, Spinal metastases, CA - Secondary cancer of spine, Secondary cancer of spine, Metastasis to vertebral column, Metastasis to spine, Secondary tumor of spine, Secondary tumour of spine, Metastatic malignant neoplasm to spine, Metastatic malignant neoplasm to vertebral column, Secondary malignant neoplasm of spine, Secondary malignant neoplasm of vertebral column (disorder), Secondary malignant neoplasm of vertebral column, Metastases to Spine, Metastases to the Spine, Metastasis to Spine, Metastasis to the Spine, Metastatic Cancer to the Spine, Metastatic Cancer to the Vertebral Column, Metastatic Neoplasm to the Vertebral Column, Metastatic Tumor to the Spine, Metastatic Tumor to the Vertebral Column
Dutch ruggenmergmetastase, ruggenmerg secondaries, wervelkolommetastasen
French Métastases rachidiennes, Tumeurs secondaires rachidiennes, Métastases vertébrales
German Wirbelsaeulen sekundaere, Wirbelsaeulenmetastasen
Portuguese Metástases espinhais, Metástases na coluna vertebral
Spanish Tumores secundarios vertebrales, neoplasia espinal metastásica maligna, neoplasia espinal secundaria maligna, neoplasia maligna secundaria de la columna vertebral (trastorno), neoplasia maligna secundaria de la columna vertebral, neoplasia metastásica maligna de la columna vertebral, Metástasis en la columna vertebral
Japanese 脊椎転移, セキツイテンイ
Czech Metastázy do páteře, Páteřní metastázy
Hungarian Gerincmetastasisok, Gerincáttétek, Gerinc metastasisok