Referral

     Emergency

• Cauda equina syndrome suspected
• Spinal infection suspected
• Abdominal aortic aneurysm suspected

    Therapy

• Physical impairments impede a return to work or activity

     Psychology

• Contextual, cognitive, or emotional factors are significantly influencing the pain experience

     Imaging

• Strong cancer risk factors - consider early x-ray (2 to 4 weeks) and blood test (CRP)
  

• Combination of vertebral fracture risk factors and not improving after4 to 6 weeks of conservatiove care - consider x-ray

• Ankylosing spondylitis risk factors and not improving after 4 to 6 weeks of conservative care - consider x-ray

Surgical review

• Severe neurological deficits (progressive motor deficits or motor deficits at multiple levels) - consider early surgical opinion
• Neurological signs indicating radiculopathy or spinal stenosis and not improving after 6 weeks conservative care