When is Spine Pain an Emergency?
So often we hear from people who are upset with Emergency Rooms because they feel their neck or back pain was not treated with the seriousness it deserved. A traumatic event such as a bad fall or a serious car accident with any sign of severe pain, or abnormal neurological signs such as paralysis, should definitely be checked for fracture or spinal cord damage. But what about the rest of the back/neck pains?
We are not lying when we say 90% of back/ neck pain gets better with little help. In fact most sprains, strains and hematomas are improved within a week. Rest, light exercise, anti-inflammatories and ice are generally adequate treatment. Some people require physical therapy, or prefer chiropractic care, but either way, if their spinal cord was not affected, taking the time for things to heal is a sensible way to treat pain.
So when is it an emergency? Severe weakness in the extremities, paralysis, new clumsiness or loss of bowel/bladder control are symptoms that should get you assessed quickly.
When there is a severe narrowing or blockage of the spinal canal in the neck or upper back, the whole spinal cord may be affected. Pressure on the spinal cord, be it from spinal stenosis, infection, fracture or herniated disc, can cause weakness and spasticity in the extremities. The patient may have some difficulty walking, or develop a tendency to drop things. There may be numbness in both the upper extremities and lower extremities and reflexes may be increased in the legs. A patient may lose their “position sense”. This is where the patient does not know the position of his arms and legs, if they have their eyes closed. It is important to note that the patient may have no pain (just weakness) if the nerve roots are not affected.
At the bottom of the spine, near where the lumbar vertebrae start, is the cauda equina. This is a bundle of nerves shaped like a horse’s tail that provide nerve function to the legs, feet and pelvic organs. In Cauda Equina Syndrome, these nerves are completely or partially blocked from sending proper messages to these areas. Symptoms include low back pain, numbness or weakness in one or both legs and a decreased sensation in the pelvic area. Loss of control over bladder or bowel function (retention or incontinence) is part of this decreased sensation and the patient may often report a new onset of sexual dysfunction or “foot drop”. Causes of Cauda Equina Syndrome include, a large lumbar disc herniation (most common), severe spinal stenosis, tumor, infection, hemorrhage or fracture.
Both of these conditions are much more serious than a sprain or strain. They may develop quickly after an accident or fall, or slowly, as in infection, stenosis or swelling. Either way, these symptoms should be reported and assessed immediately. If surgery is necessary, the sooner it takes place, the better the outcome.
- Arnold PM. Editorial. Use of anterior lumbar discectomy and interbody fusion in the management of recurrent lumbar disc herniation and cauda equina syndrome. J Neurosurg Spine. 2017 Jul 14;:1-3. PubMed PMID: 28708042
- Petr O, Glodny B, Brawanski K, Kerschbaumer J, Freyschlag C, Pinggera D, Rehwald R, Hartmann S, Ortler M, Thomé C. Immediate versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits: The Impact of Surgical Timing on Functional Outcome. Spine (Phila Pa 1976). 2017 Jun 27; PubMed PMID: 28658038