EXAMPLE ONLY - NOT FOR USE CURRENTLY - Refer to MSK triage clinic for specialist assessment including:

• MRI
• Referral to secondary care

Does the assessment warrant spinal injection or spinal surgery?

• Injection:
  • Acute and severe sciatica OR
  • Facet joint related pain (over 5/10 on VAS) and no improvement with physio
  • Lumbar Nerve Root Block/Epidural Pathway
• Surgery:
  • Radiculopathy: motor weakness
  • Myelopathy/cord compression
  • Scoliosis (imaging only if available in community)
  • Severe lumbar spine stenosis (including chronic cauda equina compression as per GIRFT pathway) and limited mobility
  • Radicular pain & correlating nerve root compression/impingement on MRI and no improvement with physio (discuss with local pain service first if only contact/abutment/irritation of nerve root)
  • Vertebral fragility fracture and bone marrow oedema on MRI