GP referral | Information for GPs | London Norwich Spine Clinic

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

GP Name *
GP Practice *
GP Telephone *
Referral Urgency * Urgent Routine
Patient Surname *
Patient First Name
Patient Address
Patient DOB
Patient Telephone
Patient Mobile
Patient Email *
NHS Number
Hospital Number
Referral Letter

* 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