Correspondence to:

A review of injuries to the spinal musculature, spinal ligaments, intervertebral discs, zygapophyseal joints (facet joints) and nerve roots. Spinal soft tissue injuries are especially common in younger more active individuals. One of the major dilemmas is to determine whether this is a ‘‘simple’ ’ soft tissue injury or whether there is a more sinister underlying injury which may predis-pose the individual to potential nerve injury or even paralysis. Staff in the emergency department often have to make a clinical diagnosis in difficult circumstances without the luxury of CT or MRI scans that are available to specialists on an elective basis. Innocuous injuries can sometimes cause severe pain, and this leads to fear, psychosomatic disorders and a vicious circle of pain, lack of movement, muscle spasm and further pain. With any spinal problem the first responsibility is to exclude any serious pathologies, and the following list of ‘‘red flags’ ’ is designed to guide the clinician towards detecting these (case history 1): c Presentation,20 years of age or onset.55 years of age c Violent trauma (eg, fall from a height, road traffic accident) c Constant progressive non-mechanical pain c Thoracic pain c Previous medical history of carcinoma c Systemic steroids c Drug abuse, HIV c Systemically unwel