{"id":27899,"date":"2026-05-14T11:13:02","date_gmt":"2026-05-14T10:13:02","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=27899"},"modified":"2026-08-07T08:19:52","modified_gmt":"2026-08-07T07:19:52","slug":"serious-cervical-spine-conditions-red-flags","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/serious-cervical-spine-conditions-red-flags\/","title":{"rendered":"Serious cervical spine conditions (Red Flags)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">These include (See referral guidelines):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Suspected cervical myelopathy<\/li>\n\n\n\n<li>Suspected vertebral fragility fractures<\/li>\n\n\n\n<li>Suspected spinal infection<\/li>\n\n\n\n<li>Suspected malignancy<\/li>\n\n\n\n<li>Suspected metastatic spinal cord compression &nbsp;<\/li>\n\n\n\n<li>Suspected vascular pathologies of the neck<\/li>\n\n\n\n<li>Deteriorating cervical radiculopathy with motor deficit grade 3 or less (Oxford scale)<\/li>\n\n\n\n<li>Widespread neurology \u2013 features not in keeping with cervical radiculopathy or myelopathy<\/li>\n\n\n\n<li>Traumatic onset neck pain<\/li>\n\n\n\n<li>Suspected inflammatory spinal conditions<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n<style>.kb-table-container27899_1a3278-38{overflow-x:auto;}.kb-table-container .kb-table27899_1a3278-38 th{padding-top:var(--global-kb-spacing-xxs, 0.5rem);padding-right:var(--global-kb-spacing-xxs, 0.5rem);padding-bottom:var(--global-kb-spacing-xxs, 0.5rem);padding-left:var(--global-kb-spacing-xxs, 0.5rem);text-align:center;}.kb-table-container .kb-table27899_1a3278-38 caption{text-align:center;}.kb-table-container .kb-table27899_1a3278-38 td{padding-top:var(--global-kb-spacing-xxs, 0.5rem);padding-right:var(--global-kb-spacing-xxs, 0.5rem);padding-bottom:var(--global-kb-spacing-xxs, 0.5rem);padding-left:var(--global-kb-spacing-xxs, 0.5rem);text-align:left;}.kb-table-container .kb-table27899_1a3278-38 td:nth-of-type(0){background-color:#E6EDF1;}.kb-table-container .kb-table27899_1a3278-38 th:nth-of-type(1){background-color:#E6EDF1;}.kb-table-container .kb-table27899_1a3278-38 td, .kb-table27899_1a3278-38 th{border-top:1px solid #323031;border-right:1px solid #323031;border-bottom:1px solid #323031;border-left:1px solid #323031;}@media all and (max-width: 1024px){.kb-table-container .kb-table27899_1a3278-38 td, .kb-table27899_1a3278-38 th{border-top:1px solid #323031;border-right:1px solid #323031;border-bottom:1px solid #323031;border-left:1px solid #323031;}}@media all and (max-width: 767px){.kb-table-container .kb-table27899_1a3278-38 td, .kb-table27899_1a3278-38 th{border-top:1px solid #323031;border-right:1px solid #323031;border-bottom:1px solid #323031;border-left:1px solid #323031;}}<\/style><div class=\"kb-table-container kb-table-container27899_1a3278-38 wp-block-kadence-table\"><table class=\"kb-table kb-table27899_1a3278-38\">\n<tr class=\"kb-table-row kb-table-row27899_757340-9b\">\n<th  scope=\"col\" class=\"kb-table-data kb-table-data27899_34c18f-1e\">\n\n<p class=\"wp-block-paragraph\"><strong>Condition<\/strong><\/p>\n\n<\/th>\n\n<th  scope=\"col\" class=\"kb-table-data kb-table-data27899_54f167-69\">\n\n<p class=\"wp-block-paragraph\"><strong>Symptoms<\/strong><\/p>\n\n<\/th>\n\n<th  scope=\"col\" class=\"kb-table-data kb-table-data27899_464c85-86\">\n\n<p class=\"wp-block-paragraph\"><strong>Signs<\/strong><\/p>\n\n<\/th>\n\n<th  scope=\"col\" class=\"kb-table-data kb-table-data27899_78e430-b1\">\n\n<p class=\"wp-block-paragraph\"><strong>Further info<\/strong><\/p>\n\n<\/th>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row27899_36f96a-9e\">\n<th  scope=\"row\" class=\"kb-table-data kb-table-data27899_75257c-9b\">\n\n<p class=\"wp-block-paragraph\"><strong>Cervical myelopathy<\/strong><\/p>\n\n<\/th>\n\n<td  class=\"kb-table-data kb-table-data27899_da2001-d8\">\n\n<ul class=\"wp-block-list\">\n<li>Stiff neck or legs <\/li>\n\n\n\n<li>Altered sensation in the legs <\/li>\n\n\n\n<li>Altered balance and staggering when walking<\/li>\n\n\n\n<li>Bilateral hand numbness<\/li>\n\n\n\n<li>Loss of dexterity (difficulty doing up buttons\/holding a pen) <\/li>\n\n\n\n<li>Clumsiness in the hands. &nbsp;<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_3744cf-73\">\n\n<ul class=\"wp-block-list\">\n<li>Hyper-reflexia<\/li>\n\n\n\n<li>Abnormal pathological reflexes (e.g. positive Hoffman, plantar response, ankle clonus)<\/li>\n\n\n\n<li>Increased tone<\/li>\n\n\n\n<li>Motor deficits<\/li>\n\n\n\n<li>Atrophy of intrinsic hand muscles<\/li>\n\n\n\n<li>A broad-based unstable, ataxic gait<\/li>\n\n\n\n<li>Bowel and bladder dysfunction<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_b164af-26\">\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/cervical-myelopathy\/\" target=\"_blank\" rel=\"noreferrer noopener\">Cervical Myelopathy \u2013 RefHelp<\/a> &nbsp; &nbsp;<\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row27899_5bb26c-2e\">\n<th  scope=\"row\" class=\"kb-table-data kb-table-data27899_b532e4-2e\">\n\n<p class=\"wp-block-paragraph\"><strong>Suspected vertebral fragility fractures<\/strong><\/p>\n\n<\/th>\n\n<td  class=\"kb-table-data kb-table-data27899_bfa77b-6e\">\n\n<ul class=\"wp-block-list\">\n<li>Sudden onset of severe central spinal pain which is relieved by lying down<\/li>\n\n\n\n<li>There may be a history of trauma (such as road traffic collision or fall from height), minor trauma, or even just strenuous lifting in people with osteoporosis or those who use corticosteroids<\/li>\n\n\n\n<li>Identified risk factors<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_dd3f25-55\">\n\n<ul class=\"wp-block-list\">\n<li>There may be point tenderness over a vertebral body. &nbsp;<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_cfc51f-c7\">\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/suspected-vertebral-fragility-fractures\/\" target=\"_blank\" rel=\"noreferrer noopener\">Suspected vertebral fragility fractures \u2013 RefHelp<\/a><\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row27899_02e6a1-83\">\n<th  scope=\"row\" class=\"kb-table-data kb-table-data27899_3ddfb0-f8\">\n\n<p class=\"wp-block-paragraph\"><strong>Suspected spinal cord compression (MSCC)<\/strong><\/p>\n\n<\/th>\n\n<td  class=\"kb-table-data kb-table-data27899_ad059a-7a\">\n\n<ul class=\"wp-block-list\">\n<li>Localised neck pain with a current diagnosis of cancer (particularly: breast, lung, prostate, kidney, thyroid)<\/li>\n\n\n\n<li>Severe, intractable progressive pain, especially thoracic<\/li>\n\n\n\n<li>New spinal nerve root pain (burning numb, shooting)<\/li>\n\n\n\n<li>Any new difficulty walking<\/li>\n\n\n\n<li>Bowel\/ bladder disturbance. &nbsp;<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_49ea82-27\">\n\n<ul class=\"wp-block-list\">\n<li>Reduced power\/ altered sensation in limbs &nbsp;<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_658ae0-05\">\n\n<p class=\"wp-block-paragraph\">See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oncology\/malignantspinalcordcompression\/\" target=\"_blank\" rel=\"noreferrer noopener\">Malignant Spinal Cord Compression \u2013 RefHelp<\/a><\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row27899_0465da-b7\">\n<th  scope=\"row\" class=\"kb-table-data kb-table-data27899_690709-26\">\n\n<p class=\"wp-block-paragraph\"><strong>Suspected malignancy<\/strong><\/p>\n\n<\/th>\n\n<td  class=\"kb-table-data kb-table-data27899_af2cc0-26\">\n\n<ul class=\"wp-block-list\">\n<li>Aged over 50 years<\/li>\n\n\n\n<li>Gradual onset of symptoms<\/li>\n\n\n\n<li>Severe unremitting pain that remains when the person is supine <\/li>\n\n\n\n<li>Aching night pain that prevents or disturbs sleep<\/li>\n\n\n\n<li>Pain aggravated by straining (e.g. bowel movements, coughing, sneezing) <\/li>\n\n\n\n<li>thoracic pain <\/li>\n\n\n\n<li>No symptomatic improvement after 4-6 weeks of conservative therapy <\/li>\n\n\n\n<li>Unexplained weight loss<\/li>\n\n\n\n<li>Current\/Previous history of cancer (breast, lung, gastrointestinal, prostate, renal, thyroid cancers are more likely to metastasize to the spine)<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_f7968c-b0\">\n\n<ul class=\"wp-block-list\">\n<li>Localised spinal tenderness &nbsp;<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_ea6b08-9b\">\n\n<p class=\"wp-block-paragraph\">If clinical assessment by GP leads to a very strong suspicion of suspected underlying malignancy, consider recommendations and referral options&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) \u2013 RefHelp<\/a> &nbsp;<\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row27899_09ba05-13\">\n<th  scope=\"row\" class=\"kb-table-data kb-table-data27899_3e33d2-69\">\n\n<p class=\"wp-block-paragraph\"><strong>Traumatic onset neck pain<\/strong><\/p>\n\n<\/th>\n\n<td  class=\"kb-table-data kb-table-data27899_cce220-9c\">\n\n<ul class=\"wp-block-list\">\n<li>Central neck pain <\/li>\n\n\n\n<li>Loss of sensation or paralysis in the body, arms, and\/or legs <\/li>\n\n\n\n<li>Pain that radiates from the neck into the arms and\/or shoulders &nbsp;<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_928aa6-1f\">\n\n<ul class=\"wp-block-list\">\n<li>Patients with traumatic neck pain are typically managed through A&amp;E. However, prior to completing a physical examination, it is important to apply the&nbsp;<a href=\"https:\/\/www.mdcalc.com\/calc\/696\/canadian-c-spine-rule\" target=\"_blank\" rel=\"noreferrer noopener\">Canadian C Spine Rule<\/a>&nbsp;if appropriate.&nbsp; <strong>&nbsp;<\/strong><\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_9a7f5e-59\">\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/traumatic-onset-neck-pain\/\" target=\"_blank\" rel=\"noreferrer noopener\">Traumatic onset neck pain \u2013 RefHelp<\/a><\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row27899_96483e-73\">\n<th  scope=\"row\" class=\"kb-table-data kb-table-data27899_df0d2c-c0\">\n\n<p class=\"wp-block-paragraph\"><strong>Suspected spinal&nbsp; infection<\/strong><\/p>\n\n<\/th>\n\n<td  class=\"kb-table-data kb-table-data27899_8114b4-74\">\n\n<ul class=\"wp-block-list\">\n<li>Fever in a patient with new neck pain <\/li>\n\n\n\n<li>Recent infection (especially skin or urinary tract)\n<ul class=\"wp-block-list\">\n<li>Cervical osteomyelitis and cervical epidural abscesses arise from haematogenous spread in most cases <\/li>\n\n\n\n<li>About one third of cases of cervical epidural abscesses arise from contiguous spread from the skin<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Tuberculosis <\/li>\n\n\n\n<li>Diabetes History of IV drug use <\/li>\n\n\n\n<li>HIV infection, use of immunosuppressants, or the person is otherwise immune-compromised<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_b8ca82-96\">\n\n<ul class=\"wp-block-list\">\n<li>Fever in a patient with new neck pain &nbsp;<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_b60374-0c\">\n\n<p class=\"wp-block-paragraph\">See referral guidelines section<\/p>\n\n<\/td>\n<\/tr>\n\n<tr class=\"kb-table-row kb-table-row27899_b0ecd1-e0\">\n<th  scope=\"row\" class=\"kb-table-data kb-table-data27899_cca2c2-15\">\n\n<p class=\"wp-block-paragraph\"><strong>Axial Spondyloarthritis<\/strong> <strong>&nbsp;<\/strong><\/p>\n\n<\/th>\n\n<td  class=\"kb-table-data kb-table-data27899_398254-99\">\n\n<ul class=\"wp-block-list\">\n<li>Back pain &gt; 3months with onset &lt;45yrs of age<\/li>\n\n\n\n<li>Does not improve on resting<\/li>\n\n\n\n<li>Insidious onset <\/li>\n\n\n\n<li>Pain at night improving on rising <\/li>\n\n\n\n<li>Early morning stiffness improving with exercise<\/li>\n\n\n\n<li>Good response to NSAID<\/li>\n\n\n\n<li>Other associated features \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/axial-spondyloarthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Axial Spondyloarthritis \u2013 RefHelp<\/a><\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_889197-87\">\n\n<ul class=\"wp-block-list\">\n<li>Reduced range of spine movements<\/li>\n<\/ul>\n\n<\/td>\n\n<td  class=\"kb-table-data kb-table-data27899_e14dad-ed\">\n\n<p class=\"wp-block-paragraph\">see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/axial-spondyloarthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Axial Spondyloarthritis \u2013 RefHelp<\/a><\/p>\n\n<\/td>\n<\/tr>\n<\/table><\/div>\n\n\n<h3 class=\"wp-block-heading\">Other considerations:<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Vascular pathologies of the neck<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">There are a range of potential vascular pathologies of the neck which have the potential to mimic musculoskeletal problems (vascular masqueraders).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Typically in addition to neck pain clinical features may include&nbsp; headache, facial pain, cranial nerve deficits, TIA\/ wider neurological symptoms will form part of the clinical picture.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vascular pathologies of the neck are rare, but are an important consideration in patients presenting with neck and head pain.&nbsp;Occurrences of vascular pathologies of the neck are complex and multifactorial. Rarely is an event associated with a single causal factor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is important to note that there is a different risk profile for dissection and non-dissection events.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dissection events most commonly present with a history of trauma, with cardiovascular factors being less common<\/li>\n\n\n\n<li>Non-dissection events most commonly occur in the presence of cardiovascular factors<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">An absence of risk factors does not necessarily rule out the risk of serious neuro-vascular event.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Guidance: <\/strong>The International Federation of Musculoskeletal Physical Therapists have produced an international framework and resource to help improve clinician awareness of the range of potential vascular pathologies which may masquerade as MSK pain and dysfunction- see here&nbsp;<a href=\"https:\/\/www.ifompt.org\/site\/ifompt\/IFOMPT%20cervical%20framework%20final%202020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">IFOMPT cervical framework final 2020.pdf<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Relevant Resources<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Headaches:&nbsp;<\/strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/headache\/\" target=\"_blank\" rel=\"noreferrer noopener\">Headache \u2013 RefHelp Page<\/a>&nbsp;(includes guide to differentiating primary headache disorders, headache as a new complaint including adult assessment<\/li>\n\n\n\n<li><strong>Facial pain:<\/strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/facial-pain-neurology\/\" target=\"_blank\" rel=\"noreferrer noopener\">Facial Pain-Neurology \u2013 RefHelp Page<\/a><\/li>\n\n\n\n<li><strong>Transient ischaemic attack (TIA) and stroke:<\/strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/transientischaemicattacktiaandstroke\/\" target=\"_blank\" rel=\"noreferrer noopener\">Transient Ischaemic Attack (TIA) And Stroke \u2013 RefHelp Page<\/a><\/li>\n\n\n\n<li><strong>Vertigo and dizziness:<\/strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/vertigo-and-dizziness\/\" target=\"_blank\" rel=\"noreferrer noopener\">Vertigo and dizziness \u2013 RefHelp Page<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A &amp; P.A &#8211; 14-05-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>GPs other primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners<\/li>\n\n\n\n<li>Secondary care consultants and associated teams<\/li>\n\n\n\n<li>MSK physiotherapists within Lothian who identify patients with suspected serious spinal condition or inflammatory spinal pain should follow agreed pathways and processes&nbsp;<a href=\"https:\/\/rightdecisions.scot.nhs.uk\/msk-pathways\/spine-pathways\/lumbar-spine-pathways\/\" target=\"_blank\" rel=\"noreferrer noopener\">Lumbar spine pathways | Right Decisions<\/a>&nbsp;and&nbsp;<a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLothianIntegratedSpinalService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Integrated Spinal Service<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who &amp; How to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Suspected cervical myelopathy-<\/strong>\n<ul class=\"wp-block-list\">\n<li>Patients with moderate \/ severe myelopathy or progressive features- Discuss with <strong>On call Neurosurgical<\/strong> registrar via switchboard 0131 242 1000<\/li>\n\n\n\n<li>Patients with mild and stable symptoms&nbsp;&#8211; Refer to <strong>neurosurgery<\/strong> \u2013 the urgency of the referral is based on the clinical presentation.<\/li>\n\n\n\n<li>If the patient has an existing diagnosis of cervical myelopathy, from a specialist team, and there is no change in their presentation, aim to optimise function and conservative management- Keep clinical presentation under review, review management if any progressive features develop as above, safety net the patient about disease progression, consider a referral to <strong>MSK physiotherapy<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Suspected vertebral fragility fractures<\/strong>&#8211; follow (<a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vertebral-Fragility-Fractures-Pathway-V21.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">VFF Pathway<\/a>)<\/li>\n\n\n\n<li><strong>Suspected metastatic spinal cord compression<\/strong>&#8211; see&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oncology\/malignantspinalcordcompression\/\" target=\"_blank\" rel=\"noreferrer noopener\">Malignant Spinal Cord Compression \u2013 RefHelp<\/a><\/li>\n\n\n\n<li><strong>Deteriorating cervical &nbsp;radiculopathy with motor deficit grade 3<\/strong> <strong>or less<\/strong>&#8211; Discuss with on call neurosurgical registrar via switchboard 0131 242 1000<\/li>\n\n\n\n<li><strong>Suspected infection<\/strong>&#8211; Discuss with on call <strong>neurosurgical<\/strong> registrar via switchboard 0131 242 1000<\/li>\n\n\n\n<li><strong>Traumatic neck pain<\/strong> \u2013\n<ul class=\"wp-block-list\">\n<li><strong>High risk patient&nbsp;<\/strong>(Canadian C-Spine Rule) &#8211; Do not physically assess the patient- Discuss with On call Neurosurgical registrar via switchboard 0131 242 1000<\/li>\n\n\n\n<li><strong>Low risk on Canadian C-Spine Rule: <\/strong>See Neck Pain section of pathway, However, if&nbsp; still have a moderate or high level of clinical concern refer to Neurosurgery<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Suspected vascular pathology<\/strong> &#8211; If there are features of concern refer\/direct to the appropriate service considering urgency. Further advice of relevance include;\n<ul class=\"wp-block-list\">\n<li><strong>Headaches:&nbsp;<\/strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/headache\/\" target=\"_blank\" rel=\"noreferrer noopener\">Headache \u2013 RefHelp Page<\/a>&nbsp;(includes guide to differentiating primary headache disorders, headache as a new complaint including adult assessment<\/li>\n\n\n\n<li><strong>Facial pain:<\/strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/facial-pain-neurology\/\" target=\"_blank\" rel=\"noreferrer noopener\">Facial Pain &#8211; Neurology \u2013 RefHelp Page<\/a><\/li>\n\n\n\n<li><strong>Transient ischaemic attack (TIA) and stroke:<\/strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/transientischaemicattacktiaandstroke\/\" target=\"_blank\" rel=\"noreferrer noopener\">Transient Ischaemic Attack (TIA) And Stroke \u2013 RefHelp Page<\/a><\/li>\n\n\n\n<li><strong>Vertigo and dizziness:<\/strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/vertigo-and-dizziness\/\" target=\"_blank\" rel=\"noreferrer noopener\">Vertigo and dizziness \u2013 RefHelp Page<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Widespread neurological symptoms \u2013<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/\" target=\"_blank\" rel=\"noreferrer noopener\">Neurology \u2013 RefHelp<\/a><\/li>\n\n\n\n<li>Suspected malignancy \u2013 If clinical assessment by GP leds to a very strong suspicion of suspected underlying malignancy, consider recommendations and referral options&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) \u2013 RefHelp<\/a><\/li>\n\n\n\n<li><strong>Suspected inflammatory spinal condition<\/strong> &#8211; Refer to Rheumatology &#8211; the urgency of the referral is based on the clinical presentation. See\u00a0<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/axial-spondyloarthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Rheumatology Axial Spondyloarthritis RefHelp Page<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>W<\/strong>ho not to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Do not refer patients to MSK Physiotherapy who have presence of significant red flags\/ suspicion of a serious spinal condition or have suspected inflammatory spinal pain.<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>These include (See referral guidelines): Other considerations: Vascular pathologies of the neck There are a range of potential vascular pathologies of the neck which have the potential to mimic musculoskeletal problems (vascular masqueraders). Typically in addition to neck pain clinical features may include&nbsp; headache, facial pain, cranial nerve deficits, TIA\/ wider neurological symptoms will form<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[424,1388],"class_list":["post-27899","page","type-page","status-publish","hentry","category-cervical-thoracic-spine","category-https-apps-nhslothian-scot-refhelp-serious-cervical-spine-conditions-red-flags"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/cervical-thoracic-spine\/\" rel=\"tag\">Cervical \uff06 Thoracic Spine<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/cervical-thoracic-spine\/https-apps-nhslothian-scot-refhelp-serious-cervical-spine-conditions-red-flags\/\" rel=\"tag\">Serious Cervical Spine Conditions<\/a>","rttpg_excerpt":"These include (See referral guidelines): Other considerations: Vascular pathologies of the neck There are a range of potential vascular pathologies of the neck which have the potential to mimic musculoskeletal problems (vascular masqueraders). Typically in addition to neck pain clinical features may include&nbsp; headache, facial pain, cranial nerve deficits, TIA\/ wider neurological symptoms will form","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27899","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=27899"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27899\/revisions"}],"predecessor-version":[{"id":27908,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27899\/revisions\/27908"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=27899"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=27899"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}