GP Red-Flag Assessment Checklist | Melbourne | Dr Ales Aliashkevich

SPINAL NEUROLOGICAL RED-FLAG CHECKLIST

Neurosurgical Clinic Screening Aid • Dr Ales Aliashkevich

Patient Name: ___________________________

D.O.B: ____ / ____ / ________

Date of Exam: ____ / ____ / ________

1. Suspected Cauda Equina Syndrome (CES)

Assess for compression of the lumbar/sacral nerve roots. Positive checks require immediate ED routing.

Saddle Anaesthesia: Reduced sensation/numbness in the perineum, buttocks, inner thighs, or perianal region. Bladder Dysfunction: New urinary retention, overflow incontinence, or difficulty initiating a stream. Bowel Dysfunction: Loss of anal sphincter control, new fecal incontinence, or fecal impaction. Bilateral Sciatica: Radiating pain, severe numbness, or progressive motor weakness in both legs (e.g., foot drop).

2. Suspected Cervical Myelopathy

Assess for cervical spinal cord compression. Positive checks require priority outpatient review (1-2 weeks).

Loss of Fine Motor Skills: Bilateral hand clumsiness, difficulty buttoning shirts, using keys, or writing. Gait Instability: Unsteadiness when walking, feeling of "walking on cotton wool," or frequent near-falls. Hoffmann's Sign: Positive (reflex flexion of thumb/index finger upon flicking the middle fingernail). Pathological Reflexes: Hyperreflexia in upper/lower limbs, or positive Babinski's sign.

3. Spinal Oncology / Infection Flags

Assess for secondary spinal tumours or epidural abscesses.

Prior Cancer History: History of breast, prostate, lung, or renal cancers presenting with new spine pain. Night Pain: Severe pain that keeps the patient awake, or is worse when lying flat/recumbent. Systemic Signs: Unexplained weight loss, fever, chills, or risk factors (e.g., intravenous drug use).