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.
Cauda Equina Syndrome
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
Last modified: December 11, 2020
In 2016 I started excruciating pain and it happened for a year and a half, went to bone doctor and they did MRI in neck because pain in back left shoulder and whole left arm feels like it’s being torn off, needles in arm and hand no biggie compared to pain. Had 2 shots in neck 3 months apart and no help. Finally excruciating pain let up from bed rest and heating pad after a year and a half, disability turn me down in nov. So I know I needed to work. Got a job on Dec. 21 and now I cry every night from pain. Please let me know if there’s some kinda help. No pain medicine works at all. Can emergency room help at all? With their drugs? They said MRI showed 7 messed up disk just in neck, narrowing, building, etc plus 2 pinch nerves. I’m scared to find out about rest of back. I was a gymnast growing up plus beat by older brother constantly. No insurance and just need some kinda help cause I know it’s worse since 2016 and now it’s 2020.
Christina, I’m sorry you are so miserable. There is very little we can help you with without seeing you. A couple of hints. Laying down with a heating pad will not help anything. Try ice and the exercises on our website.We wish you the best.
I had no idea that cervical myelopathy can occur after an accident. Ever since my uncle was rear-ended on the freeway, he has had a difficult time identifying where his arms and legs are being placed. It may be best for him to find a spine rehabilitation center for assistance.
He should see someone as soon as possible. This is one of the signs of pressure on the spinal cord.
I have 4 bulging discs in lumbar spine from accident and hospital treated me awful 6mths later with chronic pain and no surgery disgusting
Hello Eve, Most often surgery does not help bulging discs. If a disc is herniated and is pressing on the cord or a nerve root and still hurts after 3 months of conservative care, surgery is often a good option. Multiple bulging discs are much less likely to respond to surgery and very often the pain increases post-op. Please make sure you do everything possible conservatively before considering an operation. Physical therapy, chiropractic care or injections are all less invasive options. Please discuss with your physician.