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GP referral | Information for GPs | Norwich Spine Clinic

Norwich Spine Clinic

For appointments or confidential
discussion call 01603 505 063

The Norwich Spine Clinic is based at
the Spire Norwich Hospital, Norfolk

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