SpinalRisk
Clinical Evidence Base

References

The peer-reviewed systematic reviews, clinical guidelines, and primary research papers that the SpinalRisk decision logic draws upon. Every threshold, escalation pathway, and risk weighting in the tool is traceable to the evidence listed here.

Last updated: 26 June 2026  ·  Total references: 23  ·  Format: APA, alphabetical by first author

Jump to A B C D F G H J M N P R S V W

A

  1. Australian Commission on Safety and Quality in Health Care. (2022). Low Back Pain Clinical Care Standard. Sydney: ACSQHC. safetyandquality.gov.au

B

  1. British Association of Spinal Surgeons. (2022). Cauda Equina Syndrome: Clinical Guidelines for Diagnosis and Management. BASS. spinesurgeons.ac.uk

C

  1. Chou, R., Qaseem, A., Owens, D. K., & Shekelle, P. (2011). Diagnostic imaging for low back pain: Advice for high-value health care from the American College of Physicians. Annals of Internal Medicine, 154(3), 181–189. DOI: 10.7326/0003-4819-154-3-201102010-00008

D

  1. Deyo, R. A., & Diehl, A. K. (1988). Cancer as a cause of back pain: Frequency, clinical presentation, and diagnostic strategies. Journal of General Internal Medicine, 3(3), 230–238. DOI: 10.1007/BF02596337
  2. Downie, A., Williams, C. M., Henschke, N., Hancock, M. J., Ostelo, R. W. J. G., de Vet, H. C. W., Macaskill, P., Irwig, L., van Tulder, M. W., Koes, B. W., & Maher, C. G. (2013). Red flags to screen for malignancy and fracture in patients with low back pain: Systematic review. BMJ, 347, f7095. DOI: 10.1136/bmj.f7095

F

  1. Feller, D., Chiarotto, A., Koes, B., Maselli, F., & Mourad, F. (2024). Red flags for potential serious pathologies in people with neck pain: A systematic review of clinical practice guidelines. Archives of Physiotherapy, 14, 105–115. DOI: 10.33393/aop.2024.3245
  2. Finucane, L. M., Downie, A., Mercer, C., Greenhalgh, S. M., Boissonnault, W. G., Pool-Goudzwaard, A. L., Beneciuk, J. M., Leech, R. L., & Selfe, J. (2020). International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic & Sports Physical Therapy, 50(7), 350–372. DOI: 10.2519/jospt.2020.9971

G

  1. Goel, A. (2021). Indicators of atlantoaxial instability. Journal of Craniovertebral Junction & Spine, 12(2), 103–106. DOI: 10.4103/jcvjs.jcvjs_55_21
  2. Greenhalgh, S., & Selfe, J. (2006). Red Flags: A Guide to Identifying Serious Pathology of the Spine. Edinburgh: Churchill Livingstone/Elsevier.

H

  1. Han, C. S., Hancock, M. J., Downie, A., Jarvik, J. G., Koes, B. W., Machado, G. C., Verhagen, A. P., Williams, C. M., Chen, Q., & Maher, C. G. (2023). Red flags to screen for vertebral fracture in people presenting with low back pain. Cochrane Database of Systematic Reviews, 8(8), CD014461. DOI: 10.1002/14651858.CD014461.pub2
  2. Henschke, N., Maher, C. G., Refshauge, K. M., Herbert, R. D., Cumming, R. G., Bleasel, J., York, J., Das, A., & McAuley, J. H. (2009). Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis & Rheumatism, 60(10), 3072–3080. DOI: 10.1002/art.24451

J

  1. Jarvik, J. G., & Deyo, R. A. (2002). Diagnostic evaluation of low back pain with emphasis on imaging. Annals of Internal Medicine, 137(7), 586–597. DOI: 10.7326/0003-4819-137-7-200210010-00010
  2. Joines, J. D., McNutt, R. A., Carey, T. S., Deyo, R. A., & Rouhani, R. (2001). Finding cancer in primary care outpatients with low back pain: A comparison of diagnostic strategies. Journal of General Internal Medicine, 16(1), 14–23. DOI: 10.1111/j.1525-1497.2001.00440.x

M

  1. Merckling, M., Vazquez, S., Nolan, B., Subah, G., Fortunato, M., Stein, A., Spirollari, E., Naftchi, A. F., Kaur, G., Vissichelli, N. C., Mayer, S. A., Gandhi, C. D., & Al-Mufti, F. (2024). Atlantoaxial subluxation and Down syndrome: A cross-sectional analysis. Journal of Craniovertebral Junction & Spine, 15(2), 173–177. DOI: 10.4103/jcvjs.jcvjs_1_24

N

  1. National Institute for Health and Care Excellence. (2016). Low back pain and sciatica in over 16s: Assessment and management. NICE Guideline NG59. London: NICE. nice.org.uk/guidance/ng59
  2. National Institute for Health and Care Excellence. (2015, updated 2023). Suspected cancer: Recognition and referral. NICE Guideline NG12. London: NICE. nice.org.uk/guidance/ng12

P

  1. Premkumar, A., Godfrey, W., Gottschalk, M. B., & Boden, S. D. (2018). Red flags for low back pain are not always really red: A prospective evaluation of the clinical utility of commonly used screening questions for low back pain. Journal of Bone and Joint Surgery, 100(5), 368–374. DOI: 10.2106/JBJS.17.00134

R

  1. Royal Australian and New Zealand College of Radiologists. (2017). Diagnostic Imaging Pathways: Low Back Pain. ranzcr.com
  2. Rushton, A., Carlesso, L. C., Flynn, T., Hing, W. A., Rubinstein, S. M., Vogel, S., & Kerry, R. (2023). International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: International IFOMPT Cervical Framework. Journal of Orthopaedic & Sports Physical Therapy, 53(1), 7–22. DOI: 10.2519/jospt.2022.11147

S

  1. Sieper, J., Rudwaleit, M., Khan, M. A., & Braun, J. (2006). Concepts and epidemiology of spondyloarthritis. Best Practice & Research Clinical Rheumatology, 20(3), 401–417. DOI: 10.1016/j.berh.2006.01.001

V

  1. van Tulder, M., Becker, A., Bekkering, T., Breen, A., del Real, M. T. G., Hutchinson, A., Koes, B., Laerum, E., & Malmivaara, A. (2006). European guidelines for the management of acute nonspecific low back pain in primary care. European Spine Journal, 15(Suppl 2), S169–S191. DOI: 10.1007/s00586-006-1071-2
  2. Verhagen, A. P., Downie, A., Popal, N., Maher, C., & Koes, B. W. (2016). Red flags presented in current low back pain guidelines: A review. European Spine Journal, 25(9), 2788–2802. DOI: 10.1007/s00586-016-4684-0

W

  1. Williams, C. M., Henschke, N., Maher, C. G., van Tulder, M. W., Koes, B. W., Macaskill, P., & Irwig, L. (2013). Red flags to screen for vertebral fracture in patients presenting with low-back pain. Cochrane Database of Systematic Reviews, 1(1), CD008643. DOI: 10.1002/14651858.CD008643.pub2
SpinalRisk is a living tool. As new systematic reviews and guideline updates emerge, the decision logic and this reference list are reviewed and revised. Version history of significant clinical logic changes is maintained internally and documented in any submission to regulatory or research review.

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