Patients younger than 18 years old or older than 50 years
Significant trauma (or mild trauma in patients older than 50 years)
Chronic steroid use
Osteoporosis
History of cancer Recent infection
Immunocompromise
History of intravenous drug use
Pain worse at night,
lasting longer than 6 weeks,
or refractory to analgesics and rest
Associated systemic symptoms (fever, unexplained weight loss, malaise, night sweats, diaphoresis, nausea, syncope)
Acute onset Use of anticoagulants or coagulopathy
Abnormal vital signs (including unequal blood pressures or pulse deficits)
Neurologic deficits (including extremity weakness, numbness, paresthesias, loss of rectal sphincter tone, urinary retention)
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