For appointments or confidential discussion call
London Clinic 07776 511824
Norwich Clinic 01603 505063

The London Norwich Spine Clinic is based at
Hospital of St Johns & St Elizabeth, St Johns Wood, London
and the Spire Norwich Hospital, Norwich.
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Information for GPs

Who to refer

When assessing a patient with back pain, here are some general referral criteria for some of the more commonly seen spinal conditions:

Cervical Spondylopathy or Disc Prolapse

  • Intolerable or persistent (>4 - 6 weeks) Brachialgia.
  • Upper or lower limb weakness.
  • Cervical Myelopathy: Brisk reflexes, limb hypertonia, impaired hand dexterity, imbalance and walking difficulties, urinary frequency and urgency.
  • Intolerable side effects from strong analgesia

Lumbar Disc Prolapse

  • Persistent (>4 - 6 weeks) or intolerable Sciatica (L5, S1) or Femoralgia (L1 - 4).
  • Leg or ankle weakness.
  • Intolerable side effects from strong analgesia.

Lumbar Spinal Stenosis

The natural history is usually that of fluctuating symptoms and a trend of gradual deterioration over 6 to 18 months. The indications for referral to a spinal specialist for further assessment and surgical intervention are:

  • Failure of conservative management with progressive neurogenic claudication
  • Incapacitating neurogenic leg pain, leg weakness or imbalance upon standing or walking
  • Bowel or bladder dysfunction

GP referral form

  • * required

Red flags for Serious Spinal Pathology

The presence of the following may indicate a serious underlying spinal pathology. If a serious condition is suspected, an urgent or emergency referral directly to the local spinal unit may be necessary.

Red Flags for Spinal Metastases

  • Constant severe mechanical spinal pain
  • Progressive spinal pain despite conservative treatment
  • Persistent thoracic spine pain
  • Patient is under 20 or over 50 with back pain for the first time
  • Personal or family history of cancer.
  • Unexplained weight loss, cachexia, loss of apetite.
  • Structural deformity of spine

Red Flags for Spinal Infection

  • Constant severe spinal pain which continues when resting and may worsen at night
  • Unexplained fever, malaise or lethargy
  • Recent bacteraemic infection, UTI, or endoscopic procedure
  • Immune suppression risk factors: Diabetes, alcohol dependence, IV drug misuse or HIV
  • Structural deformity of spine

Red Flags for Cauda Equina Syndrome

  • Recent onset urinary retention with overflow incontinence
  • Recent onset faecal incontinence
  • Bilateral sciatica, leg numbness or weakness
  • Progressive neurological deficit in the legs
  • Perineal / saddle anaesthesia
  • Lax anal sphincter

Red Flags for Spinal Fracture

  • History of fall or spinal trauma
  • History of osteoporosis
  • Long-term steroid medication