When are Back Problems an Emergency?

Surprisingly, severe back pain isn't usually a sign of a medical emergency

One of the most common reasons people go to the emergency room is severe back pain from a simple muscle strain. While the strain can be extremely painful, it usually doesn't indicate tissue or other structural damage to the back. The emergency room doctors will probably prescribe a few days of rest, some type of pain relief medication (e.g., ibuprofen or acetaminophen), and ice / heat therapy for the strain. Learn more in First steps in caring for low back pain.

There are some back-related problems, however, that could very well indicate a medical emergency. You should seek medical help immediately if you experience any of the following. Remember -- it's always better to be safe than sorry when it comes to:

Progressive weakness in the legs or loss of bladder or bowel control

The sudden onset of bladder and/or bowel incontinence and/or progressive weakness in the lower extremities can be an indication of a relatively rare but serious condition called Cauda equina syndrome. Anyone experiencing these symptoms should seek immediate medical attention. Typical symptoms of Cauda equina include:

• Altered sensation, or severe or progressive weakness or numbness in the lower extremities - the legs and/or feet
• Loss of sensation or altered sensation in the "saddle" area (the area or your body that would sit on a saddle: inner thighs/between the legs, buttocks, back of legs, sacral region)
• Loss of control of bladder or bowels (including retention or incontinence)
• Pain, numbness or weakness in one or both legs that may cause difficulty walking

Cauda equina syndrome is caused by the compression of nerves in the lumbar spine, which can happen from a trauma to the spine, any spinal condition that may compress the nerves (such as a disc herniation, spinal stenosis), or an infection. Left untreated, this syndrome can ultimately result in paralysis, as well as continued loss of sensation in areas below the lower spine. Learn more about lower back pain.

Unexplained lack of appetite, weight loss, pain, or neurological problems

Weight loss from increased exercise or changes in diet can be healthy and can help reduce back pain. However, sudden weight loss and/or lack of appetite for no known reason can be indicative of a serious medical condition, such as cancer. Several symptoms of a tumor in the spine include:

• Pain in the neck or back, followed by neurological problems (such as weakness or numbness of the arms or legs or a change in normal bowel or bladder habits) are the most common symptoms of a spinal tumor
• Back pain that does not diminish with rest, and pain that may be worse at night than during the day
• Any of the above symptoms along with loss of appetite, unplanned weight loss, nausea, vomiting, or fever, chills or shakes

Read more in Could my back pain be cancer?

Fever, some type of increased pain, and other symptoms of infection

Fever can indicate an infection. A spinal infection can either occur quickly (e.g., within 1-2 weeks following fusion surgery) or develop over time (e.g. in elderly persons or those with compromised immune systems). Spinal infections are rare, but can be quite dangerous if the infection moves into the spinal canal and causes an epidural abscess (a pus-filled cavity in the epidural space). Pressure from an abscess pressing on the nerve structures in the cervical or thoracic spine can result in paraplegia or quadriplegia.

Wound infections after spine surgery occur in about 1% of patients, with certain groups (e.g., diabetics or persons with other medical conditions) more likely to develop infections than others. A wound infection after spine surgery may present the following symptoms: fever (>101 degrees), increasing redness around the incision, increasing pain and a change in the drainage from the wound. Learn more in One to four weeks after spine fusion surgery.

An infection of the vertebral body in the spine (called vertebral osteomyelitis) is also quite rare, especially in young healthy adults. It is usually spread to the spine by veins which bring bacteria from other parts of the body. There are a number of possible causes of this condition, such as a urologic procedure (e.g., cystoscopy, a diagnostic test using a thin telescope to inspect the bladder, often prescribed when there is blood in the urine or before prostate surgery), intravenous drug abuse, or long-term use of steroids to treat rheumatoid arthritis. Read more in Osteomyelitis, a spinal infection.

Severe, unrelenting abdominal and lower back pain

The pain of an abdominal disorder can often extend to the back and be felt as acute, continuous low back pain. Acute lower back pain can be a symptom of an enlargement of the aorta (large artery) in the abdomen, called an abdominal aortic aneurysm. If the blood vessel ruptures or starts leaking blood this could become a serious medical emergency.

The primary symptoms of an abdominal aortic aneurysm are severe, continuous abdominal and lower back pain. This is a life threatening condition. Anyone with these symptoms needs to seek immediate medical attention. Learn more in Abdominal aortic aneurysm.

The above conditions are quite rare compared to the common causes of back pain, and most conditions that cause back pain do not require immediate medical care. This newsletter discusses these rare conditions to help provide an awareness of symptoms that could be dangerous and that do need immediate care. We hope that this information broadens and deepens your understanding of these back conditions.

Best wishes,
Peter F. Ullrich, Jr., MD, Medical Director
Stephanie Burke, President

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com. The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board.The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.