Red flags are signs and symptoms that may indicate a serious cervical spine pathology. Some red flags include clinically relevant trauma, neck pain worse at night or with weight loss which could signal a neoplasm or tumor, and fever or chills which may point to an infection. Neurological issues like progressive deficits in the upper or lower extremities could suggest problems like cervical nerve injuries or myelopathy.

1. Red flags for
Cervical Spine

2. Red flags:
Red flags are signs and symptoms found in the
patient history and clinical examination that may
tie a disorder to a serious pathology.
2

3. fracture
●Clinically relevant trauma in
adolescent or adult
●Minor trauma in elderly patient
●Ankylosing spondylitis
3
The vertebrae of the cervical spine are frequently fractured; C2
(~30%) and C7 (~20%) are
the most commonly fractured vertebrae
Ankylosing spondylitis is an inflammatory disease that, over time,
can cause some of the small bones in your spine (vertebrae) to fuse.
This fusing makes the spine less flexible and can result in a hunched-
forward posture.

4. Neoplasm
•Pain worse at night
• Unexplained weight loss
• History of neoplasm Age of more
than 50 or less than 20 years
• Previous history of cancer
•Constant pain, no relief with bed
rest

5. “
● Intramedullary Tumor
● An intramedullary tumor grows inside the spinal cord
and typically arises from the cells that provide physical
support and insulation for the nervous system (glial
cells). These tumors occur most often in the cervical
spine (neck).
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6. Infection
● Fever, chills, night sweats
● Unexplained weight loss
● History of recent systemic infection
● Recent invasive procedure
● Immunosuppression
● Intravenous drug use
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7. Spine infections that involve the vertebrae
are called vertebral osteomyelitis. An
infection of the disc is called discitis; an
infection with pus within the spinal canal is
called an epidural abscess.
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Plain x-rays of the spine will show subtle signs of endplate
erosion and destruction, but usually this is not evident in the
first 1-3 weeks of a pyogenic infection. The most sensitive
imaging test for a spine infection is a magnetic resonance
imaging test (MRI) with gadolinium.

8. ●Progressive neurologic
deficit
●Upper and lower extremity
symptoms
●Bowel or bladder
dysfunction
Neurologic injury
"Burners," "Stingers," Brachial Plexus
Injuries, Quadriplegia, and
Quadriparesis
Cervical nerve root and spinal cord
injuries are among the most common
cervical spine neurologic (nerve)
injuries.
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9. Cervical myelopathy
●Sensory disturbance
of the hands
● Muscle wasting of
hand intrinsic muscles
●Unsteady gait
●Hoffman reflex
●Hyperreflexia
●Bowel and bladder
disturbances
●Multisegmental
weakness and/or
sensory changes
Cervical myelopathy is
a form
of myelopathy that
involves compression
of the spinal cord in
the cervical spine
(neck).
The Hoffman sign is an
involuntary flexion
movement of the
thumb and or index
finger when the
examiner flicks the
fingernail of the
middle finger down.
The reflexive pathway
causes the thumb to
flex and adduct quickly
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10. Upper cervical ligamentous
instability
●Occipital headache and
numbness
●Severe limitation during
neck active ROM in all
directions
●Signs of cervical
myelopathy
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11. Vertebral artery insufficiency
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•Drop attacks
•Dizziness or lightheadedness related to neck movement
•Dysphasia
•Dysarthria
•Diplopia
•Positive cranial nerve signs
Dysphagia is the medical term for swallowing difficulties.
Dysarthria is a motor speech disorder in which the muscles that are
used to produce speech are damaged, paralyzed, or weakened.
Diplopia is when you see two images of the same thing.
Drop attacks are sudden spontaneous falls while standing or walking,
with complete recovery in seconds or minutes.

12. Inflammatory or systemic disease
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•Temperature more than 37° C
• Blood pressure more than 160/95 mm Hg
•Resting pulse more than 100 bpm
•Resting respiration more than 25 bpm
Fatigue