When is Spine Pain an Emergency?

When is Spine Pain an Emergency?

When is Spine Pain an Emergency?

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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?

Let’s talk……

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.

Cervical Myelopathy

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.

Citations

  • 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

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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