“Patient w/ severe back and left leg pain that started yesterday afternoon. Pt was moving couch when he heard a pop in his left lumbar region. Over the subsequent few hours he developed gradually increasing pain in his low back that radiates down the posterolateral side of his left leg and onto the top of his left foot. He describes the pain as lancinating and knife-like, rating it as 10/10 on a pain scale. He is unable to stand up straight or sit down comfortably for an examination. He denies any bowel or bladder dysfunction and appears to have otherwise intact strength and sensation. Prior to this event he was in good health and took no routine medications.” ABFM
-No red flags presents
When there are no red-flags like cauda equina syndrome, symptoms suggestive of cancer, infection, or fracture that would suggest the presence of a time-sensitive condition, consensus agreements recommend against any imaging studies. Instead, a 6-week course of pain medication, manipulation, physical therapy, and self-care should be undertaken.
Red flags present
-Need imaging and urgent action…
References
Ann Intern Med 2007;147(7):478-491. 2)
ACR Appropriateness Criteria: Low Back Pain. American College of Radiology, 2015.