Table 2 Grouped red flags as per the spinal imaging guidelines [11]

Neoplasm

History of Cancer (withing the last 15 years), Unexplained weight loss (> 4.5 kg over 6 months), Considerable LBP (NRS ≥ 8) and Age ≥ 50, failure of conservative care

History of cancer, failure of conservative care

History of cancer, considerable LBP and age ≥ 50

Spinal fracture

Recent significant trauma (any age)

Severe pain (NRS ≥ 8) with minor trauma, Age ≥ 50

History of prolonged corticosteroid use

Structural deformity

History of/high risk for osteoporosis

Spinal infection

Documented fever (> 38.3 °C) > 3wks, no established diagnosis, age ≥ 50

Diabetic

Immunosuppressed

Embedded Foreign object

IV drug abuse

Inflammatory low back pain

Morning stiffness > 30 min, improvement of pain with exercise but not rest, awakening 2nd half of night due to back pain

Any two of (morning stiffness > 30 min, improvement of pain with exercise but not rest, awakening 2nd half of night due to back pain)

Suspected sciatica—lumbar disc herniation, spondylolisthesis, degenerative spinal stenosis

Progressive neurological deficits with at least one of (age ≥ 50, failure of conservative care, significant activity limitations)