AQP Lower Back and Neck

AQP Physiotherapy

This guideline applies to people over 16 years of age with neck or lower back pain with a duration of one year or less.

Red Flag Features

Cauda equina syndrome

Conus medullaris syndrome

Trauma

Cervical spondylotic myelopathy

Significant neurological symptoms or signs

Unintentional weight loss

Loss of appetite

Fever

Systemically unwell

Night sweats

Pain that is particularly bad at rest such as lying down and at night

Past medical history of cancer

Thoracic back pain

Insufficiency fractures with severe pain

Early morning stiffness lasting for 30 minutes or more

Urgent criteria

Patient is dependent on strong analgesia such as tramadol
Severe sleep disturbance due to the MSK condition
Deterioration is likely to significantly and quickly deteriorate without intervention
Severe impairment of daily living activities

Routine criteria

All referrals not categorised as urgent including

Exclusions

Patients younger than 16 years
Suspicion of serious pathology and red flags
Symptoms over 1 year in duration
Thoracic pain
Generalised loss of muscle power
Spasticity, hyperreflexia, increased tone reflexes or clonus that could indicate a central nervous system problem
Patients with a primary peripheral limb problem with secondary neck or low back pain (ie. primary problem is from the hip, shoulder, foot or gait abnormalities)
Women over 35 weeks’ pregnant
Housebound patients
Patients who are not registered with a general practitioner in locality

Referral

Red flags and alternative pathology

Suspected Cauda Equina or Conus Medullaris Syndrome direct to ED
Metastatic spinal cord compression admit via AcuteGP service
Trauma direct to ED
Cervical spondylotic myelopathy
Low back pain with sustained slowly progressive motor or sensory loss with cauda equina/conus medullaris and red flags excluded, discuss with on call neurosurgery by phone or via www.referapatient.org or urgent referral depending on clinical urgency
Spinal infection including suspected discitis, osteomyelitis and spinal abscess, discuss with on call neurosurgery by phone or via www.referapatient.org depending on clinical urgency
Primary spinal tumour found on MRI imaging, discuss with on call neurosurgery either by phone, via www.referapatient.orgor urgent referral depending on clinical urgency
Malignancy without suspected cauda equina or metastatic spinal cord compression, consider blood/urine and imaging work up, refer to appropriate specialty fast track suspected cancer if suspected primary or non site specific pathway if unknown primary
Features of inflammatory arthritis, inflammatory spinal pain or other suspected rheumatological causes, workup and refer to rheumatology

AQP Referral

Referral Form

References

Joint societies guideline. Urgent and Emergency Musculoskeletal Conditions Requiring Onward Referral, December 2020

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