Serious/specific spinal pathologies
- Metastatic spinal cord compression
- Multiple myeloma
- Spinal infection
- Inflammatory spondyloarthropathy
- Osteoporotic compression fracture
- Cervical instability
- Cervical myelopathy
- Cauda equina syndrome
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Serious spinal masqueraders
- Cervical vascular lesions
- Abdominal aortic aneurysm
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Special questions:-
- PMH Malignancy:- (particularly breast/ lung/ prostrate/ thyroid/ kidney)
- Major trauma
- Minor trauma if osteoporotic
- Structural deformity
- Systemically unwell
- Severe, unremitting night pain
- Non mechanical pain, constant or progressive
- Systemic steroid use
- PMH TB/ HIV
- History of IVDA
- Unexplained weight loss (5-10% body weight in 3-6 months)
- Inflammatory signs and symptoms
- Previous inflammatory history – joints/systemic condition/first degree relative
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- Subjective history not matching objective findings
- Fatigue/ malaise
- Alcohol/ drug abuse
- Smoking
- CES questioning
- Gait disturbance
- Unable to lie flat
- Dizziness/ dysarthria/ dysphagia/ diplopia/ drop attacks (5D’S)
- Clumsy hands
- Gait disturbance
- Altered taste
- Lhermitte’s sign
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The Assessment, Diagnosis and Management (ADAM) tools can aid with screening for serious spinal pathologies.
RefHelp - NHS Ayrshire and Arran
