Progressive lower back pain

Severe or progressive low back pain with radicular or neurological features.

Eligibility

At least one must be met for the patient to be eligible for referral.

Severe or progressive low back pain with appropriate imaging where indicated (MRI/CT for neurogenic claudication, radicular symptoms or suspected serious pathology)

Red flags

Indicate urgent (Category 1) referral or emergency assessment.

Spinal nerve root or cord compression with rapidly progressive neurological signs or suspected cauda equina syndrome — refer to ED

Present or suspected ruptured abdominal aortic aneurysm — refer to ED

Suspected spinal infection — refer to ED

Recent spinal trauma or fracture with neurological deficits — refer to ED

New diagnosis of spinal tumour with neurological deficits — contact neurosurgery registrar immediately

Routine referral criteria

Determine Category 2 or 3 urgency.

Persistent or increasing radicular symptoms despite ≥3 months of physical therapy, medications (analgesia or corticosteroid injections) and psychological treatment where required

Progressive neurological deficit (e.g. foot drop, abnormal lower-limb tone)

Worsening neurogenic claudication (reduced walking distance or time)

Signs of serious pathology (malignancy, infection, fracture risk)

Usually managed in primary care

Low back pain that is not progressive
Low back pain where ≥3 months of physical therapy, medications and psychological treatment (where required) has not been trialled
Referrals based on incidental imaging findings without clinical significance
MRI/CT not required in the absence of serious pathology; X-rays only if vertebral fracture suspected