–
Abnormal CBC, Sed Rate, etc.
Bladder and Bowel dysfunction
Fever
Cancer, History of
Immunocompromised state
IV drug use
Major weakness of a limb
Pain increased at rest
Saddle anesthesia
Severe pain, not repsonding to opiates after two days
Trauma
Unexplained weight loss
Urinary tract infections
1. Nonsteroidal anti-inflammatory drugs for at least three weeks (Requirement is waived if NSAIDS are not tolerated or contraindicated, or if condition worsens while under treatment.)
2. Activity modification or physical therapy if appropriate
1.1 Bilateral radiculopathy SEE MYELOPATHY
1.2 Bladder dysfunction This is a RED FLAG. No conservative management is required.
1.3.1 Failed Conservative Management
1.4 Bowel incontinence This is a RED FLAG. No conservative management is required.
1.5 Clumsiness, increasing with time
1.6.1 Myelopathy suspected
1.7.1 Failed Conservative Management
1.8.1.1 Failed conservative management
1.8.1.2 Known malignancy elsewhere This is a RED FLAG. No conservative management is required.
1.8.2.1 No RED FLAGS, Failed conservative management
1.8.2.2.1 AIDS
1.8.2.2.2 ESR elevated
1.8.2.2.3 Fever
1.8.2.2.4 Immunosuppressed
1.8.2.2.5 White count elevated
1.8.2.2.6.1 AS Baker, RG Ojemann, MN Swartz, and EP Richardson Spinal epidural abscess; N. Engl. J. Med., Sep 1975; 293: 463 – 468.
1.8.2.2.6.2 Davis DP; Wold RM; Patel RJ; Tran AJ; Tokhi RN; Chan TC; Vilke GM The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med 2004 Apr;26(3):285-91.
1.8.2.2.6.3 Darouiche RO; Hamill RJ; Greenberg SB; Weathers SW; Musher DM; Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore) 1992 Nov;71(6):369-85 [abstract]
1.8.2.2.6.4 David T Durack, MD, DPhil Daniel J Sexton, MD Epidural abscess UpToDate 15.2 accessed 07/09/07
1.8.3 Severe pain, not responding to opiates or worsening, This is a RED FLAG. No conservative management is required.
1.8.4.1 Radiculopathy or disc disease suspected. Failed conservative management
ent-item”>1.8.4 Shooting pain, in nerve root distribution