When is Back Pain an Emergency?
Over 90% of back pain episodes are mechanical, settle within a few weeks, and do not need scans or a specialist. But a small number of patients have pain caused by something that must not be missed — nerve compression, infection, fracture or tumour.
Doctors use a list of “red flags” to pick out these patients. If you have back pain together with any of the features below, you should be seen promptly rather than waiting for it to settle.
The most urgent of all is cauda equina syndrome, where the bundle of nerves at the bottom of the spinal canal is compressed. It is rare, but the outcome depends on surgery within hours.
Red Flags: See a Doctor Promptly
Back or neck pain plus any of the following:
- Pain at rest or at night that wakes you, or pain that is steadily getting worse
- Fever, chills, or recent infection (skin, urine, chest) — possible spinal infection or TB
- Unexplained weight loss, or a past history of cancer — possible spinal tumour
- Pain after a fall or accident, especially if you are over 60 or have osteoporosis — possible fracture
- Weakness in a leg or foot, or a foot that slaps or drags
- Numbness or tingling in both legs, or unsteady walking (see cervical myelopathy)
- Long-term steroid use, or a weakened immune system
Cauda Equina Syndrome: Go to Hospital Now
The cauda equina (“horse’s tail”) is the bundle of nerve roots below the end of the spinal cord that controls the bladder, bowel, sexual function and the legs. A large central disc prolapse, fracture, tumour or abscess can compress it. Symptoms:
- Numbness around the back passage, genitals or inner thighs (“saddle” numbness)
- Difficulty starting to pass urine, loss of the feeling of a full bladder, or leaking
- Loss of bowel control or inability to feel the bowel opening
- New sexual dysfunction
- Severe pain, weakness or numbness in both legs
Do not wait for a clinic appointment. Go to an emergency department the same day; an urgent MRI and decompression surgery within 24–48 hours give the best chance of recovering bladder and bowel function.
What Happens Next
Assessment
A red flag does not mean something serious is definitely wrong — it means it must be checked. Assessment usually involves:
- A detailed history and neurological examination
- Blood tests for infection and inflammation when indicated
- X-rays for suspected fracture
- MRI, the key test for nerve compression, infection and tumour
In most patients the tests are reassuring and treatment continues as for ordinary back pain.
Emergency Treatment
When a serious cause is confirmed, treatment is directed at it:
- Cauda equina syndrome: emergency surgery to remove the compression
- Spinal infection or TB: antibiotics or anti-tubercular drugs, with surgery if there is an abscess, instability or cord compression
- Unstable fracture: bracing or surgical fixation
- Tumour: a planned combination of surgery, radiotherapy and oncology care
If you are unsure whether your symptoms count as a red flag, call the clinic on +91 8376828820 and describe them — it is always better to ask.