Let’s discuss overall spinal health and some red flags that would make a person go see a doctor like yourself so in addition to back pain what are some other red flags people should look out for okay so so here this is sort of a vague list of red flags so pain in the extremities or more weakness in the extremities as a red flag so oftentimes when we have a herniated disc VAL compressing or root no cause focal pain but it’s more really the weakness or the numbness that are more of a concerning feature versus just the pain itself okay unwanted weight loss fevers chills and sweats that more points towards a malignancy and that could be something that would be metastatic cancer that’s gone to the spine or spinal tumor that’s happened to nobo okay groin numbness incontinence usually the classic thing we talk about is fecal incontinence and urinary retention so what you would have is you would sow yourself and you would go to the toilet and you would say okay well I’ve soiled myself and I actually hadn’t noticed the stool coming out that’s very different from patients who say they can’t make it to the bathroom on time but have the sensation of emptying right or urinary retention which means that they’re going and they’re going and they’re going but they never really fully empty the bladder and get something called overflow incontinence right which is where you know you use your bladder is so full that essentially just sort of empties itself so it’s not really urinary incontinence so much it’s the fact that you can’t empty your bladder got it and at what point look looking at these red flags are they indicative of like something that may need surgery so any of those red flags for example fecal incontinence urinary retention numbness or weakness in the legs those are not something that we try a non-operative treatment for that’s generally find out what the problem is with imaging so the x-rays CT scans and MRIs and then proceed with operative intervention because once you develop the neurologic deficits which is what those are it’s really there’s no role for conservative management’s right at that point if the patient is fit for surgery at all you