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Back pain emergency 

At some point in our lives many of us will experience some form of back pain, most of these cases are not an emergency. Occasional back pain can be managed with over-the-counter anti-inflammatory drugs and/or a heating or ice pad or a combination thereof. There are times, however, when the pain requires urgent medical attention. Surgery is on the rare end of many pain related issues with many procedures being elective. There are six potentially serious conditions that should not be ignore and we detail them in this article.

There are some red flag warnings which should under no circumstances be ignored. Back pain is quite a common occurrence and tends to be ignored. The following signs and symptoms require urgent medical intervention:

  • Disabling spinal pain, neck and lower back included,
  • Loss of bladder or bowel function,
  • Weakness or numbness in the extremities such as arms and legs,
  • Difficulty walking or balancing,
  • Loss of sensation in the groin, buttocks and/or inner thighs,
  • Difficulty controlling hands or finer motor skill issues,
  • Any head trauma after an accident, such as motor vehicle or sports injuries should be assessed immediately.

No. 1 Cauda Equina Syndrome

This is a rare occurrence that needs immediate medical intervention. Cauda Equina Syndrome (CES) is a spinal disorder involving a bundle of nerves which forms in the lumbar spine or the spinal cord of the lower back. The nerves are called the cauda equina which in Latin means “horse’s tail”, drawing on its frayed appearance for description. This bundle of nerves is responsible for supplying the function and sensation to the legs, bladder and intestines.

CES is caused by anything that may cause compression of these nerves in the lumbar spine region. The causes include but are not limited to disc herniation, spinal tumor, infection, fractures, trauma or injury. To be on the lookout certain symptoms persist such as severe lower back pain, loss of sensation or function in one or both of the legs, loss of bladder or intestinal function or general loss of sensation. If you are experiencing any one of these it is imperative to consult with a doctor immediately.

No. 2 Myelopathy

There are different types of myelopathy, such as thoracic myelopathy (back) or cervical myelopathy (neck). Each case occurs as a result of compression of the spinal cord at various points. It occurs as a result of any compression to the spinal cord such as a disc herniation, tumour, infection or trauma. Symptoms include: Loss of intestinal function, loss of bowel or bladder control; disabling pain; extremity weakness, numbness or tingling. 

Myelopathy is a serious condition, which becomes increasingly severe with time. If the spinal cord compression is left untreated the symptoms will worsen in severity. Additionally, patients who suffer from myelopathy are at an increased risk of acute spinal cord injury following any spinal cord trauma.

No. 3 Herniated disc

Also known as ruptured discs, herniated discs occur when the center of one, or more, of our intervertebral discs breaks through its exterior wall and spills out thereby causing pressure to any nearby spinal nerve roots and/or the spinal cord itself. Degenerative changes attributed to aging and/or daily wear and tear on the spine may also cause herniated discs. Improper lifting techniques, obesity, poor posture or abnormal stress to the spine are all cause for increase disc damage.

What makes a herniated disc severe enough for urgent medical attention? At times the herniation can be so large that it causes multiple nerve root compressions simultaneously. It may also compress nerve roots resulting in severe pain, weakness or numbness that need to be surgically treated. In any of these cases it is important to seek medical attention immediately.

No. 4 Spinal fracture

A spinal fracture occurs when a vertebral bone in the spinal column breaks. There are two broad causes of spine fractures: Trauma – during a motor vehicle accident or falling down the stairs, the vertebral bones break due to excessive external force. If this is the case, you should seek immediate medical intervention. Secondly the vertebral bones weaken and fracture due to disease – pathological spine fractures. Osteoporosis, a metabolic bone disease that disrupts the body’s ability to rebuild/maintain bone mass and strength, is the most common cause of this type of spinal fracture. Other less common causes are spinal infections and spine tumors or cancer. Any spinal fracture can potentially threaten the stability and alignment of your spinal column and may cause spinal cord compression spinal cord injury, cauda equina syndrome, as well as other neurological problems. 

No. 5 Spinal infections

Any type of spinal infection is serious and requires immediate medical care and treatment. Infections of the spine can be caused by bacteria, fungi, or tuberculosis (a type of bacteria). There are different naming conventions applied which are dependent on where the infection is located: Osteomyelitis: Infection of the bone, in the case of spinal infection the vertebral bone is infected. Discitis: Infection of the disc between the vertebral bones. Abscess: A collection of infected material.

A spinal infection can develop when the bacteria causing an infection elsewhere in the body travel to and infect the spine. Spinal infections, therefore, may also be secondary conditions. The hallmark symptom is severe pain but may also be accompanied by: Fever or chills; weight loss; muscle spasms and/or neck or lower back stiffness.

Spinal infections may cause spinal cord compression, spinal cord injury, cauda equina syndrome, as well as other neurological problems and should be treated immediately.

No. 6 Spinal cancer

Cancer of the spine may cause spinal cord compression, CES and/or spinal fractures. Most spinal tumors are metastatic, this means that the cancerous cells travelled from another part of the body to the spine. This happens when cancel cells break away from the original site and move through the bloodstream and/or lymph system to the spine. When these cells settle and thrive in the spine, they can form new tumors. These new tumors can then cause direct pressure on the nerves or spinal cord. Additionally, the tumors may weaken the bone and cause a pathologic fracture of the vertebrae. Rarely – spinal cord tumors may develop within the spinal tissues as the primary cancer site and are as serious as they cause similar problems within the spine.

All cases of spine cancer should be evaluated by a medical professional.

Can’t decide if you need medical help? You should definitely seek medical advice if this is the case.

Most ER cases involving back pain are not a serious cause of concern and with the proper medical care can be easily treated. When back pain starts to interfere with your daily life it should not be ignored and requires immediate attention. The spinal disorders outlined here often require surgery, however, acting quickly may prevent the potential for permanent nerve damage. If you experience any of the emergent symptoms described, you should seek medical attention right away.

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