Lumbar Spine Algorithm

An interactive decision flowchart for low back pain. After red flag screening it works through age over 65 with no pain on sitting, an abnormal Romberg with the two-stage treadmill test, dermatomal pain with neurological deficit, straight leg raise under 60 degrees and the Slump test, lumbar flexion over 53 degrees with segmental spring testing, the Hicks clinical prediction rule for hypermobility and aberrant movement, and the inflammatory pattern of morning stiffness improving with exercise, onset before 40 and chest expansion of 2.5 cm or less. It separates lumbar canal stenosis, lumbar radiculopathy, segmental instability, axial spondyloarthritis, specialist referral, and the lumbar spine being an unlikely source.

Written for qualified clinicians. The tool supports clinical reasoning; it does not replace examination, imaging or diagnosis.