BACK AND NECK PAIN COMMON PROBLEM OR LIFE-THREATENING EMERGENCY? ROBERT TALAC, M.D., PH.D.

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1 BACK AND NECK PAIN COMMON PROBLEM OR LIFE-THREATENING EMERGENCY?

2 Let s calm your fears from the outset if you are experiencing back and neck pain, you do not need to immediately panic and assume something is wrong with you. Although it can be unpleasant, back and neck pain on its own rarely indicates a medical emergency. In fact, back and neck pain is the second most reported medical complaint after the common cold. Many things can cause back and neck pain, and the condition frequently resolves on its own. If non-acute back and neck pain is your only symptom, rest assured that it s perfectly safe to take an over-the-counter pain pill, rest, and wait for a few days to see if the pain subsides before contacting your primary care provider (PCP) or spine specialist for further guidance. What concerns physicians is the combination of back and neck pain with a specific set of symptoms. When this combination of symptoms occurs, it is a strong possibility that the culprit is a spine condition. In this situation, time is of the essence. You should seek medical attention preferably from a spine specialist as soon as possible because even small and seemingly minor symptoms of spine conditions can escalate quickly. Waiting a day or two can have life-altering occasionally even life-threatening consequences. An essential organ extending down the center of the back from the skull to the tailbone, the spine is an important and complex hub of musculoskeletal and neurological activity. The spine is a bony structure comprising a series of 24 vertebrae held together by ligaments and muscles to enclose and protect the spinal canal, which contains a network of nerves that transmit signals from the brain to the rest of the body. More important than identifying the location, intensity, and timing of back and neck pain is looking for a change in the function of your musculoskeletal and neurologic systems. Put simply, you want to look for negative changes in muscle strength, coordination, balance, sensation, your ability to stand and walk, and your control over your bladder and bowels. These changes can be red flags for nerve dysfunction. Without medical intervention, nerve damage can be irreversible and devastating. It is also possible that someone suffering from back and neck pain in combination with certain symptoms could be experiencing a condition unrelated to the spine but equally serious and deserving of prompt medical attention. After all, some symptoms are associated with multiple diagnoses and can mean different things in different circumstances. Let s explore the symptoms of a medical emergency that you need to watch out for in more detail. Symptom 1 - Back and Neck Pain Combined with Progressive Leg Weakness and Loss of Bladder and/or Bowel Control Perhaps you experience pain alongside weakness or numbness in your hips, groin, or legs. You may have a difficult time standing up and walking even collapsing. Or perhaps you experience pain with the sudden inability to empty your bladder or bowels or the reverse problem, having your bladder or bowels empty uncontrollably. This is a serious problem likely caused by cauda equina syndrome, or the severe compression of lumbar nerves in the spinal column that result in a loss of function in the lower part of your body. 1

3 Think of the nerves that run through your spinal column like a network of electric cables that power your home. If the supply of electricity shuts off, vital functions within your home stop working your HVAC system fails to put out cool or warm air, you have no lights, and your appliances no longer store or prepare food and wash clothes properly. It s the same situation within your body, where nerves regulate your muscles. When pressure is applied to nerves, the outgoing signals that power your muscles are blocked and cannot be sent. As a result, certain muscles in your body simply stop working. A ruptured disc between vertebrae or cysts from adjacent joints are the most common causes of nerve compression. Additional causes of compression include bleeding that results from a vessel within the spinal canal bursting; bleeding that results from a medical procedure performed near the spinal canal, such as an epidural; or a spinal infection, in which a buildup of pus exerts pressure on nerves. In fact, in patients who are immune compromised such as drug abusers, alcoholics, diabetics, or people who have recently undergone surgery physicians assume that back or neck pain in combination with leg weakness and loss of bladder or bowel control is a spine infection, unless proven otherwise. Without immediate treatment, cauda equina syndrome can result in paralysis, permanent loss of sensation in the pubic or groin area, and permanent loss of bladder or bowel control. This can be an extremely distressing, stigma-carrying condition that removes patients dignity and leads to social isolation. Symptom 2 - Back and Neck Pain, Especially at Night, Combined with Neurological Dysfunction and Unintended Weight Loss and/or Loss of Appetite It is important to note that these symptoms don t necessarily have to occur together to constitute an emergency. On its own, unintended, rapid weight loss more than 5 pounds per week for at least a few weeks or loss of appetite, even for favorite foods, can be a symptom of cancer. However, the additional presence of neck and back pain accompanied with neurological dysfunction opens up the possibility that a patient with these symptoms could have a spine condition. Increased back and neck pain at night is significant because most aches are mechanical in nature, meaning that they are associated with working or a certain activity that usually occurs during the day. At night when you are lying down in bed, you shouldn t feel more pain than you do while working or engaging in your usual activities unless a problem exists. Our neurological system governs our movement (function) and sensation (feeling). Any change in movement or sensation is a neurological dysfunction. Persistent tingling and numbness, otherwise known as pins and needles, are commonly reported as initial symptoms. When the condition advances to the next stage, you may experience weak legs, weak arms, or the inability to stand, walk, or hold objects. 2

4 Symptom 3 - Lower Back Pain Spreading Into the Abdomen Spine conditions rarely, if ever, cause pain in the abdomen. However, certain abdominal disorders can manifest as lower back pain. If you experience a combination of abdominal and lower back pain, or even just sharp lower back pain that never subsides, it could be a symptom of a serious abdominal disorder requiring immediate medical attention: Kidney disease/stones Gallbladder disease/gallstones (it s uncommon but possible to experience pain in the lower back with this condition) Pregnancy Diverticulitis (inflammation of the colon that occurs primarily in older people) Abdominal aortic aneurysm (AAA) From an emergency-recognition perspective, an AAA is especially worrisome. An AAA is a lifethreatening condition that occurs when the aortic vessel that travels from the heart down through the abdomen to the lower extremities forms an aneurysm a saclike, football-shaped widening in its wall. The wall is susceptible to the creation of aneurysms when it is weakened by faster growth than it can adapt to similar to how a stretch mark forms. Patients suffering from an AAA often experience pain in the lower back and abdomen so severe that they are unable to stand up straight. They are also endangered by the risk of the blood vessel rupturing, which results in massive intraabdominal bleeding. Sometimes, an AAA provides warning signs that give patients valuable time to seek medical help. Other times, the wall of the blood vessel ruptures without warning and patients bleed to death. Once identified, an AAA must be fixed with surgery. Symptom 4 - Back and Neck Pain Combined with Fever and/or Chills It is the presence of a sustained fever a temperature of at least F for a period of 24 to 48 hours and chills alongside neck and back pain that necessitates seeing a physician. Fever and chills indicate an inflammation, or infection, somewhere in the body. Another less common symptom of an infection is sweating, especially at night. Alongside back and neck pain, this set of symptoms raises concerns that an infection is impacting the spine. Because the spine is so vascularized meaning that blood vessels run throughout the spinal canal an infection can originate from anywhere in the body and easily travel to the spine through blood and transfer from segment to segment (other parts of the spine). When an infection reaches the spine in a healthy person, the body reacts by producing white blood cells to fight bacteria, clean debris, and fix damaged tissue. In immune-compromised patients, the infection kills white blood cells and destroys affected tissues, which creates a thick, viscous fluid known as pus. Buildup of pus exerts pressure on and compresses nerves. Meanwhile, if bacteria grow uninhibited, the infection can morph into a life-threatening condition. This is marked by a rapid decline in neurological function and permanent paraplegia or quadriplegia. 3

Conclusion Remember: Back or neck pain on its own may be uncomfortable, and eliminating the pain may be desirable, but it shouldn t raise alarm bells that you re in immediate danger.

5 Conclusion Remember: Back or neck pain on its own may be uncomfortable, and eliminating the pain may be desirable, but it shouldn t raise alarm bells that you re in immediate danger. However, any symptoms involving back or neck pain combined with neurological changes are strong indicators of a spine condition and require timely medical attention from your PCP or spine specialist within 12 to 48 hours. Otherwise, the risk for nerve damage exponentially increases. Once nerve damage has occurred, it cannot be undone, and this may have a significant impact on your quality of life. Ideally, you should see a spine specialist who is trained to identify spine conditions. This will expedite the diagnostic process and the start of your treatment plan, and reduce the risk of an incorrect diagnosis. The diagnostic process will begin with a neurological exam to document whether your symptoms are progressively worsening. Once a specific condition is suspected, you will undergo a more advanced diagnostic technique, such as magnetic resonance imaging (MRI). When it comes to your nerves, proactive care can prevent disasters. It s far preferable to exercise an abundance of caution than to underestimate this particular cluster of symptoms. The risk is far too great. Now that you understand the difference between routine pain and a more worrisome condition, what symptoms to watch out for, and what action to take when these symptoms occur, there is no need for you to risk the health of your nerves and the ability of your body to function properly. Robert Talac, M.D., Ph.D. DR. TALAC is the founder of the Advanced Spine Institute in Houston, Texas. With a clinical practice that is 100% focused on treatment of spine-related problems, he is also dedicated to advancing patient care through clinical research. He has served as the lead author of more than 50 research publications and has contributed to several textbooks about spine surgery. The International Association of Orthopedic Surgeons has recognized Dr. Talac as a Top Orthopedic Spine Surgeon. Additionally, Dr. Talac is a multiple-year winner of the Patient Choice Award and Most Compassionate Doctor Award. This honor is bestowed upon physicians who receive near-perfect scores in patient surveys and reflects the difference that physicians can make in the lives of their patients. Only 5% of the nation s 830,000 active physicians are accorded this honor by their patients. 4

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