Neurologic Compromise

Neurologic symptoms do not necessarily mean the patient will need surgery. Leg neurologic symptoms may indicate nerve involvement from an acute disc issue or another source of neural compromise. Low back pain with pain, numbness, tingling, sensory loss, strength loss, or reflex loss down one or both legs warrants referral. Saddle anesthesia is a major red flag because it may indicate severe neural compromise requiring immediate surgical evaluation. Bowel or bladder control changes paired with low back or neurologic symptoms are serious referral signs. Positive Babinski or Hoffmann signs may indicate nervous system involvement beyond routine musculoskeletal pain.