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Back and Neck Pain

  

These are guidelines for most patients most of the time. Like all guidelines, there are exceptions. Acute back pain is for < 6 weeks, chronic > 6 weeks


Spinal Pathways Summary for Back and Neck Pain

Acute back pain is defined as < 6 weeks & chronic back pain > 6 weeks

MRI for low back pain (without serious neurological deficit or red flags eg indicators of infection or neoplasia) does NOT affect clinical outcome. In most cases with back pain (especially low back pain), the MRI should be considered a prelude to surgery, ie to guide the surgeon to a surgical target.

Spinal XR is usually not helpful, unless looking for osteoporotic collapse in the elderly

If you need to discuss a patient, ring Neurosurgery registrar on bleep 2300.

On a Wednesday ring T&O registrar on bleep 2699. If in doubt, ask

CLICK HERE FOR RED FLAG INFORMATION

Click on each of the scenarios below for further information

Scenario

 

Primary Care (GP)

 

MRI 

 

Secondary Care 

 

Notes

 

                                                1. Back Pain/Neck Pain. No red flags/radicular symptoms/neurological signs. Acute or chronic

 

Yes

 

 

No

 

 

No

 

 

                      Consider referral to physio

 

 

                                                2. BP/NP, with radicular symptoms > 6 wks (eg sciatica). No red flags or neurological signs

 

 

Yes

 

 

 

Yes (usually; GP). Routine (to occur within 4 wks, and reported in 48 hours)

 

 

 

No, not routinely

 

 

 

 

                                                                                    Refer to physio when MRI requested. Physio referral to NS/T&O may be needed if symptoms persist for 6 weeks and MRI abnormal (to be seen within 4 wks of referral)
                                                3. BP/NP with neurological signs > 2/52 (eg foot drop, arm weakness/paraesthesia)

 

 

Yes

 

 

 

Yes (GP). Urgent (to occur within 2 wks, and reported in 48 hours)

 

Yes. Usually needs to be seen by NS/T&O

 

                                                                                    Refer urgently to NS/T&O (to be seen within 2 wks from MRI)

 

 

                                                4. BP/NP with red flags (eg Spinal Cord Compression, infection/neoplasia) Yes. Send patient to ED with letter for ED Consider (ED). Immediate (< 4 hours, if requested)                             ED, and refer to NS/T&O if appropriate                                                             See NS/T&O if appropriate (or gen med, oncology etc)
                                                                                               5. Cauda Equina Syndrome

 

Yes. Send patient to ED with letter for ED Yes (ED). Immediate (<4 hours)                             ED, and refer to NS/T&O if appropriate                                                             See NS/T&O

 

                                                                                                 6. Rapidly progressive cervical myelopathy

 

 

 

 

 

 

A. Days/weeks – Yes. Send patient to ED with letter for ED

Yes (ED).               Immediate (<4 hours)  

ED, and refer to NS/T&O if appropriate

                                                            See NS/T&O

 

B. Months – Yes

 

 

Yes (GP). Urgent (to occur within 2 wks, and reported in 48 hours)

 

Yes. Usually needs to be seen by NS/T&O

 

                      Refer urgently to NS/T&O (to be seen within 2 wks from MRI)

 

 Notes

At present all MRIs (via PACS) have been connected across the West Midlands. So, if necessary, a Neuro/Spinal T&O surgeon can view the scan carried out in a referring hospital.

These include UHCW, GEH (Nuneaton), SWFT (Warwick), Worcester Royal Hospital and Alexandra Hospital (Redditch).

GPs: it is important to be aware of addictive nature of opiates and pain modulating drugs (gabapentin and pregabalin). These should only be prescribed for short periods.

 

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