Spine

Demographics
- Age
- Occupation
pain
- location
  - point to where the pain is
    - leg versus back
- radiation
  - exact location
    - L4
    - L5
    - S1
- Type
  - Burning, sharp, dull

how long
how did it start
- injury or insidious
progression
- better, worse, same

when
- Mechanical
- Rest, night pain
- Constant
Aggravating, relieving
- Hills
  - Neuropathic
    - extension & walking downhill
    - ¯ walking uphill & sitting
  - vascular
    - walking uphill
      - generates more work
    - ¯ rest
      - standing is better than sitting due to pressure gradient
- stairs
- shopping trolleys
- coughing, straining
- sitting
- forward flexion
Associated
- Paraesthesia
- Numbness
- Weakness
  - L4
  - L5
  - S1
- Bowel, Bladder
- Stiffness
- Deformity
- Cervical myelopathy
  - Clumsiness of hand
  - Unsteadiness
  - Manual dexterity
Red Flags
- Loss of weight
- Constitutional symptoms
- Fevers, sweats
- Night pain, rest pain
- History of trauma
- immunosuppression
Functional
- Home
  - Walking distance
  - Shoes, socks
  - Stairs
  - Hills
- Work
  - Manual vs office
  - Lifting, vibration, sitting
- Sport
Treatment
- Nonoperative
  - Medications
    - Analgesia
    - How much
    - How long
  - Physio
  - Orthotics
    - Walking sticks
    - Braces
- Operative
Past Medical History with emphasis on Risk Factors
- Family history
- Risk factors
  - Smoker
- Shx
  - occupational
- Prognostic factors
- Management issues

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.