# SpinalRisk

> SpinalRisk is a free, evidence-based clinical decision support tool that screens back and neck pain for serious spinal pathology across five risk categories: fracture, cancer, infection, neurological compromise, and inflammatory conditions. It is built and maintained by Movement First International and is live at https://spinalrisk.com. Patients and clinicians answer structured clinical questions and receive investigation recommendations in under three minutes.

SpinalRisk uses combination-weighted clinical logic derived from systematic reviews and clinical guidelines (including the Downie et al. 2013 systematic review, the Williams et al. 2013 and Han et al. 2023 Cochrane reviews, the Finucane et al. 2020 international red flags framework, NICE NG59, and the ACSQHC Low Back Pain Clinical Care Standard). Unlike single-flag checklists, it requires the convergence of multiple risk factors — weighted against age and sex — before recommending investigation. This reduces unnecessary imaging while escalating genuinely high-risk presentations. A small number of high-value single signs (for example a visible spinal contusion, positive likelihood ratio 31.09 for vertebral fracture, or a history of malignancy) escalate on their own.

SpinalRisk produces one of six outcome tiers: Emergency, Urgent, Imaging, Medical Review, Monitor, or Conservative. It is a screening aid that supports clinical judgement and does not replace assessment by a qualified healthcare professional.

## Key pages
- [SpinalRisk home and triage tool](https://spinalrisk.com/index.html): Overview and the live assessment.
- [Frequently asked questions](https://spinalrisk.com/faq.html): Direct answers on spinal red flags, when imaging is needed, and how the tool works.
- [Clinical references](https://spinalrisk.com/references.html): Full alphabetical reference list — peer-reviewed systematic reviews, clinical guidelines, and primary research papers the decision logic draws upon.
- [Technology vision](https://spinalrisk.com/vision.html): The clinical-integration and machine-learning roadmap.
- [Privacy policy](https://spinalrisk.com/privacy.html)
- [Terms of use](https://spinalrisk.com/terms.html)

## Clinical scope
- Conditions screened: vertebral fracture, spinal malignancy and metastasis, spinal infection (discitis, vertebral osteomyelitis), neurological compromise including cauda equina syndrome, and inflammatory spondyloarthropathy.
- Audiences: patients with back or neck pain, general practitioners, physiotherapists and allied health, and emergency department clinicians.
- Imaging guidance: MRI is prioritised over CT or X-ray for patients over 60 to minimise cumulative radiation exposure.

## About
- Creator: Stuart Cox, B.Phty, MPH — physiotherapist and Clinical Director, Movement First International.
- Organisation: Movement First International (https://movementfirst.org).
- Contact: contact@movementfirst.org