Back pain is a common symptom that can be the harbinger of serious disease, particularly in elderly patients. Separation of serious pathologies such as malignancy, infection, and cauda equina syndrome from benign axial back pain is a challenge. The red flags have clinical use for assisting in obtaining key features in the history and examination that may relate to sinister pathology. Knowing what and when to refer to a spinal specialist such as an orthopaedic surgeon or neurosurgeon is important. Cervical radiculopathy, myelopathy, and scoliosis may require specialist skills for discectomy, decompression, and reconstruction. This article deals with the assessment and treatment of cervical myelopathy and scoliosis.