<keypoints>
- Red flags indicate potentially serious pathology such as **fracture, malignancy, infection, or cervical cord compression** and necessitate immediate investigation and/or specialist referral
- Key red flags from history: significant trauma, history of cancer, constitutional symptoms (fever, weight loss), IV drug use, immunosuppression, steroid use, age >55 at first onset, severe unremitting night pain
- Key red flags from examination: upper motor neuron signs (hyperreflexia, clonus, positive Hoffmann's/Babinski), gait disturbance, bowel/bladder dysfunction, progressive neurological deficit
- Also consider **cervical arterial dissection (CAD)** in younger patients (<55) with acute onset of unfamiliar severe headache or neck pain, especially after minor trauma
- Vascular red flags (5Ds and 3Ns): dizziness, diplopia, dysarthria, dysphagia, drop attacks, nystagmus, nausea, numbness (perioral)
</keypoints>
Red Flags by Category
Serious Spinal Pathology (Fracture, Malignancy, Infection)
| Red Flag | Condition to Consider |
|---|
| Significant trauma (e.g. fall in osteoporotic patient, MVA) | Bony/ligamentous disruption |
| History of cancer | Metastatic disease |
| Constitutional symptoms: fever, weight loss, anorexia | Malignancy, polymyalgia rheumatica, giant cell arteritis |
| Fever, meningism, immunosuppression, IV drug use | Infection: epidural abscess, discitis, SAH |
| Prolonged corticosteroid use | Pathological fracture, infection |
| Age >55 at first onset |
