Musculoskeletal & Rheumatology

Saddle anesthesia, new bowel/bladder dysfunction (urinary retention or incontinence), bilateral leg weakness/numbness — a surgical emergency requiring urgent MRI and referral.

Age >50, history of cancer, unexplained weight loss, pain unrelieved by rest or worse at night, and symptoms lasting >4-6 weeks despite conservative care.

Fever, IV drug use, recent infection or invasive procedure, immunosuppression, and progressive pain — concern for vertebral osteomyelitis or epidural abscess.

Most acute LBP is self-limited: reassure, encourage staying active (avoid bed rest), use NSAIDs or acetaminophen and heat; no early imaging without red flags.

Image/refer when red flags are present (cauda equina, infection, malignancy, fracture) or when there is a progressive neurologic deficit; otherwise defer imaging.