Purpose: Cauda Equina Syndrome (CES) is a frequently cited red flag in patients presenting with back pain and is considered a surgical emergency. The purpose of this paper is to review the current literature on CES, to establish consensus on its definition, clinical presentation and possible aetiology.

Methods: The databases (Medline 1951 →, Embase 1974 →, Cinhal 1982 →) were searched using the key words Cauda Equina Syndrome and:

Definition,

The findings from these searches were coded to identify individual aspects of CES. The consistency of each aspect was then classified using The Guidelines Development Groups format (where 100% coverage = ‘unanimity’; 75–99% = ‘consensus’; 51–74% = ‘majority view’; and 0– 50% = ‘no consensus’), and the findings summarized.

Results: The electronic searches revealed 104 papers comprising case reports, case studies, literature reviews, expert opinion and papers based on clinical experience.

From these, there were widely varying descriptions of the definition, clinical presentation and aetiology of CES, and no individual aspects reached 100% agreement. The individual aspect with greatest agreement was found to be bladder dysfunction.

Conclusion: Cauda Equina Syndrome is considered a discrete clinical entity; however there is inconsistency within the literature as to its definition, clinical presentation and aetiology. To document its prevalence, clarity in definition is needed. Identifying this surgical emergency is paramount for all those who undertake spinal assessments.

Purpose: ‘Red flags’ are patient responses and findings on history taking and physical examination that are associated with an increased risk of serious spinal disorders. The purpose of this paper is to identify red flags reported in the low back pain literature, establish consensus on whether (or not) they are considered red flags, and review the evidence for these signs and symptoms.

Methods: The following databases were searched using key words ‘red flag’ and ‘low back pain’:

MEDLINE (1951→)

In addition, national guidelines and key texts were hand-searched. Each red flag identified in the literature was classified using The Guidelines Development Group’s format (where 100% coverage = ‘unanimity’; 75–99% = ‘consensus’; 51–74% = ‘majority view’; and 0–50% = ‘no consensus’), and the findings summarized.

Results: The electronic searches revealed 54 papers, with the resultant ‘red flags’ ranging from ‘no consensus’ to ‘unanimity’. Evidence for these signs and symptoms is variable. Case reports and series justify labelling some features ‘red flags’, whilst others owe their label to clinical experience and expert opinion.

Conclusion: Case reports and series should be reported/ published to help identify those signs and symptoms suggestive of serious spinal disorders and those more likely to be ‘red herrings’. Despite their importance, there is inconsistency within the literature in identifying true red flags and, an ability to identify these signs and symptoms is essential for all who practise spinal assessments.