This tool guides clinicians step-by-step through the spinal pathway. Before proceeding, please ensure you have ruled out red flags for serious spinal pathology:
Red flags to rule out: spinal infection, cauda equina syndrome, spinal fracture, and cancer. If any red flags are present, refer urgently to emergency department or appropriate specialist service.
Select the relevant red flag(s) below for guidance on urgent referral:
Refer urgently to emergency department. Follow the GIRFT national suspected cauda equina pathway.
Refer urgently to emergency department or spinal surgery for urgent MRI and antimicrobial therapy.
Trauma: Refer urgently to the emergency department.
Fragility Fracture: Follow the GIRFT Vertebral Fragility Fracture Pathway.
Refer urgently to oncology/spinal surgery. If there is a suspicion of Metastatic Spinal Cord Compression, follow the MSCC pathway.
MRC grade 3/5 or below — refer urgently to hospital spinal surgical service.
Refer to rheumatology urgently. NICE guidelines
Trauma in patient with confirmed Ankylosing Spondylitis — refer to ED due to high risk of fracture.