Inability to adequately control pain in ED with analgesics
Normal neurological function
Low risk of metastatic disease or vertebral or epidural abscess
Back Pain without severe trauma
Non Surgical imaging (if obtained)
Frequent ED visits for back pain – suspected habitual patient/narcotic addicted
Acute motor deficit (i.e. foot drop, loss of extension of foot or 1st toe, loss of bowel or bladder function)
Imaging with critical findings including cauda equina, unstable fracture, fluid collection etc
High suspicion for cord compression, metastatic disease, epidural bleed or abscess, discitis
Fever
Erector Spinae Plane Block (if not done in main ED). Ask Zeccola, Ashdown, Hanson, Prendergast, Saxon
Analgesics—Narcotic, muscle relaxers, NSAIDS as appropriate
Serial exams
IR Vertebroplasty
Physical therapy consultation as needed. PT consult is not likely to improve the patient's pain in acute setting, however PT can help for mobility assist device recommendations, mobility training for reduced pain, coping strategies for safety.
Consultation as needed – Ortho/spine, social service
Imaging (CT or MRI) if indicated to rule out acute surgical disease
Disposition
Ability to ambulate and care for self at home with oral analgesics
Pain at a tolerable level for discharge home
No worsening in neurological exam
Inability to tolerate pain while on oral medications
Inability to ambulate or care for self at home, including Rehab recommendation for SNF/ARF referral
Worsening neurologic exam
Abnormal imaging warranting inpatient admission