Assessment, Diagnosis and Management (ADAM) tool - Spinal

The goal of diagnostic triage of spinal pain is exclude non-spinal causes and to allocate patients to one of these three broad categories.

1. Serious or specific spinal pathology. The incidence of this is generally <1%. The ADAM tool offers a quick reference but please refer to red flag document for further details of signs and symptoms of this.
2. Radicular syndromes, includes spinal stenosis. The incidence of these are 5-10% of spinal cases. This may present as pain on its own, or associated with altered/loss of sensation, reduction or absence of reflexes and/or reduced power in the dermatomes and myotomes associated with the affected nerve root(s). Patients with stenosis may have normal neurology but have neurogenic claudication when walking.
3. Non-specific low back pain describes pain between the lower edge of the ribs and the buttock but can also refer to the leg in a non-radicular pattern. This accounts for 90-95% of spinal cases and it is not possible to identify a specific disease or structural cause. It can be acute, sub-acute, persistent and/or recurrent. No specific guidelines are published for non-specific thoracic or cervical pain but current evidence suggests the principles for low back pain should be applied.