Alarm bells

Back/neck pain or radiating lower limb/upper limb pain -failed to improve after reasonable conservative care

Pain after trauma (relative to age)

Pain at rest or at night; Not relieved by changing position

Weakness in arms or legs

Difficulty in passing urine or stool

Disturbed gait

Fever or unexplained weight loss (>10 kgs within 6 months)

Age of onset < 20 years and> 55 years

Obvious deformities