New framework for assessing and managing people with serious spinal pathologies

Rehabilitation clinicians and other health care professionals now have a framework for assessing and managing people who may have serious spinal pathologies. Detailed in a position statement about red flags for serious spinal injuries and disease, this new guidance for clinical practice was developed for the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) and published online this month in the Journal of Orthopaedic & Sports Physical Therapy® (JOSPT®).

While rare, serious spinal pathology can have devastating and life-changing consequences, and must be identified early and managed appropriately. This framework is intended to provide clinicians with a clinical-reasoning pathway to clarify the role of red flags in recognizing spinal injuries and disease."

Laura M. Finucane, MSc, BSc, FCSP, FMACP, lead author of the statement and vice president of IFOMPT

IFOMPT drew on the expertise of 100 experts from 19 countries to synthesize current research and reach consensus on the framework. Seventy clinicians from 13 countries, supported by patient partners, reviewed the information and approved the final version of the framework and its decision tools.

The framework covers four serious spine pathologies: cauda equina syndrome, compression of the nerve roots at the base of the spinal cord; spinal fracture, which accounts for the largest number of serious pathologies of the spine; spinal malignancy, which includes cancers that have spread from a primary cancer site to bone; and spinal infection, which includes infectious disease affecting spinal structures. For each pathology, decision tools summarize the red flags; outline the risk factors, symptoms, signs, and initial investigations; and offer a series of scenarios illustrating how red flags may raise suspicion of that condition.

The framework identifies the level of concern clinicians should have and the clinical action they should take, based on available pathways for therapy or referral to specialist care.

"While they often lack high-quality empirical evidence, red flags remain the best tools available to the clinician to raise suspicion of serious spinal pathology when used in the context of a thorough, subjective patient history and physical examination," Finucane says. As a result, the framework's authors urge clinicians to consider both the evidence to support red flags and the individual profile of their patient to decide how concerned they are that a serious condition exists.