Disease | History, symptoms and signs | Urgency of referral to specialized care; see also indications for surgery here |
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Disc herniation, spinal stenosis associated with cauda equina syndrome, excruciating pain and a fresh paresis of one of the muscle groups of the lower extremity | Difficulty initiating urination, urinary retention or incontinence, anal incontinence, perineal anaesthesia (saddle sensory loss), usually symptoms of lower limb paralysis and a clear sensory disturbance | Immediate referral to a unit with possibility to carry out immediate imaging and surgery |
Ruptured aortic aneurysm, acute aortic dissecation | Sudden, excruciating pain, age above 50 years, instable haemodynamics | Immediate referral to a unit with possibility to carry out immediate imaging and surgery |
Malignant tumour | Age above 50 years, history of cancer, involuntary weight loss, recurrent febrile episodes, progressive symptoms, pain at rest, duration of pain for over one month, paraparesis | Urgent referral; immediate referral in paraparesis |
Bacterial spondylitis | Previous back operation, urinary tract or skin infection, immunosuppression, glucocorticoid medication, abuse of intravenous drugs | Immediate referral |
Compression fracture of the spine, sacral fracture | Age above 70 years, history of falling, peroral glucocorticoid medication | Immediate referral if paresis is present, otherwise referral by appointment |
Spondylolisthesis | Adolescent (age 8-15 years) | Referral by appointment |
Spinal stenosis | Age above 50 years, neurogenic claudication | Referral by appointment |
Ankylosing spondylitis | Age below 40 years at the onset of symptoms, pain is not alleviated by bed rest, morning stiffness, duration at least 3 months | Referral by appointment |