Urgent imaging is required for patients who present with the following “red flag” conditions:

 

Cauda equina syndrome  

spine emergency

 

 

Classically defined as urinary retention, saddle anesthesia of the perineum, bilateral lower extremity pain, numbness, and weakness

 

Decreased rectal tone may be a relatively late finding

 

 

Suspected infection

discitis-osteomyelitis

 

 

Risk factors include immunosupression or IV drug use

  • fever may only present in 1/3 of patients
  • pain is often severe and insidious in onset
  • pain is usually unrelenting  and worse with activity
  • pain that awakens patients at night should raise concern for infection

 

 

Suspected epidural abscess

 

 

Risk factors include immunosupression or IV drug use

  • relentless spinal pain is the most common presenting complaint
  • neurological findings are absent in the majority of early presentations
  • fever present in 60% to 70% of otherwise healthy individuals

 

 

Suspected epidural hematoma

 

Risk factors include trauma, recent spinal procedures, and coagulopathy

 

May present with acute pain but no neurological symptoms

 

 

Suspected cancer

 

Past history of cancer

  • pain is often severe and insidious in onset
  • pain is usually unrelenting  and worse with activity
  • pain that awakens patients at night should raise concern for malignancy

 

 

Suspected compression fracture

 

Risk factors include trauma and osteoporosis

 

Severe or progressive neurologic deficit

 

 

Defined and reproducible motor or sensory deficit

this does not include isolated neuropathic pain or paresthesia

 

 

2012 Canadian Association of Radiologists Diagnostic Imaging Referral Guidelines

http://www.car.ca/en/standards-guidelines/guidelines.aspx