Back pain in the under 20s would appear to be a ‘red flag’ of dubious significance: Results of a retrospective case note analysis

Abstract Purpose To assess whether being under the age of 20 is a significant ‘red flag’ in the presentation of first time low back pain. Method Retrospective case note analysis of patients under 20 years of age, referred into a secondary care service with pain (not deformity) over a 1-year period. Results The case notes of 86 new patients were reviewed. One patient with a serious pathology was identified, an eosinophilic granuloma. Fifty-six patients presented with non-specific mechanical spinal pain. Nine patients presented with a spondylolysis with or without associated spondylolisthesis and seven with disc degeneration/prolapse with nerve root pain. Thirteen patients (15%) received invasive treatment, six undergoing surgery (pars inter-articularis repair and discectomies), and seven had an injection (pars inter-articularis blocks, facet joint injections, transforaminal nerve root blocks or caudal epidural). Conclusion This study does not support the hypothesis that being aged under 20 years at the time of presentation alone is a specific risk factor for serious pathology in patients with spinal pain.