Please see below for the policies relating to back and spine. To view the policy, patient leaflet and additional information, please click on the relevant heading.

Low back pain/radicular pain

Non-specific - the cause in the vast majority of people: It is often impossible to find a precise cause for low back pain. Less than 1 in 100 people have a serious problem. It can be caused by an injury or sprain, but most of the time it isn't and may be due to poor posture, lack of exercise or stiffness. You may have heard your doctor, physiotherapist or nurse describing your back pain as 'non-specific' or 'simple' back pain. This means that after your examination, the clinician is not concerned that you have a serious medical condition. This is the type of back pain that is likely to get better over the next few weeks as you gradually return to normal activities and work.

Sciatica: This is far less common and affects less than 1 in 20 people. It is most often caused by pressure or irritation of nerves as they come out of the lower back. The symptoms include pain, numbness and tingling that spread down the leg, sometimes reaching the calf or foot. Most people do recover from sciatica over time but often it takes longer than with non-specific back pain.

Rare causes: In less than 1 in 100 cases back pain has a more serious cause. These include infection, fracture, tumour or inflammation.

  • Severe pain that doesn't improve
  • If you have had a fall that caused your back pain to start
  • If you have had cancer in the past
  • If you are taking steroid tablets or have osteoporosis
  • If you have a fever or are generally unwell
  • If you have difficulty or changes in passing urine or opening your bowels
  • Numbness around your genitals or back passage
  • Weakness of the leg(s) that is getting worse.

About 8 out of 10 people will get back pain at some point in their lives; it often re-occurs but will settle for most people in a matter of weeks.

The doctor, physiotherapist or nurse will be able to diagnose your problem by taking a full history of your difficulties and an examination of your back and legs. Investigations such as X-rays and scans are rarely needed as they don't help the clinicians to diagnose your problem and they don't provide a cure. X-rays involve a dose of radiation so need to be used responsibly.

It is advisable to take painkillers; this can be guided by your GP or pharmacist. It is best to take them regularly rather than taking them now and again. This will allow you to continue with day-to-day activities more comfortably.

A gradual return to exercise and general activity is very helpful for your recovery. Regular exercises may also help to prevent the back pain from returning. Try to set a new goal everyday - for example, a walk around the house on one day and a walk to the shops the next day.

Try not to rest in bed; pace your activities. Pay attention to your posture and your back position when lifting. Try not to slouch when sitting and keep your back straight when lifting. You are more likely to stay pain-free in the future if you keep active rather than resting a lot.

You may want to consider taking a painkiller just before bedtime. Some people say that a small pillow in between their knees helps them to sleep.

Pain doesn't equal harm. Most people recover quickly and have no lasting problems. Sometimes people do become worried or depressed. Please see your GP if you think this is a problem for you

If you have a job, try to return to work as soon as possible. It is safe to return to work before you are pain-free. Talk to your GP and your employer about this at an early stage to assist your speedy return to work. The longer you stay off work, the more likely you are never to return. Research tells us that you are more likely to improve quickly by getting moving and getting back to work as soon as possible.

  • For more information, search for 'low back pain' at www.nhs.uk
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

Vertebral augmentation

This guidance is produced by The Academy of Medical Royal Colleges (the Academy) as part of the Evidence-based interventions programme. It is based on recommendations from the Expert Advisory Committee and the National Institute for Health and Care Excellence (NICE).

All guidance has been reviewed by the Birmingham and Solihull & Sandwell and West Birmingham CCGs’ Treatment Policy Clinical Development Groups (TPCDG). This was reviewed to establish if existing CCG policies were already in place which covered the proposed intervention / treatment in question.

Where there was no current CCG policy for the area in question, the NHSEI policy has been implemented in full into the CCG’s Clinical Treatment Policy portfolio.

Where there was a current CCG policy for the area in question, then the existing CCG policy has been reviewed by the TPCDG considering the NHSEI EBI policy rationale and evidence base.  A decision has then been taken by TPCDG based on the review as to the most appropriate policy for implementation by taking into account the healthcare needs of our local population.

The aims of the Evidence Based Interventions programme is to ensure the quality and safety of patient care by, freeing up valuable resources such as time so that more effective interventions can be carried out, reducing harm or the risk of harm to patients, helping clinicians maintain professional practice, creating headroom for innovation, and maximising value and avoiding waste.

© Keele University 01/11/14, funded by Arthritis Research UK. Content used with permission from Keele University's STarT Back Screening Tool Website, or the NHS UK website.