When to see a spinal surgeon
Summary of most common reasons:
- Any injury to the neck or back.
- Back or neck pain with or without tingling / numbness in the arm and the legs.
- Any weakness in the arms and legs.
- Back or neck pain associated with spasm, fever, loss of appetite specially in the elderly and immunocompromised.
- Loss of bladder and bowel control and perineal sensory loss / alteration with or without back or neck pain.
- Back or neck pain with history of cancer.
- Neck pain with pain / tingling in the arms with deteriorating hand function with or without instability during walking with or without loss of bladder and bowel control.
There has been tremendous myths associated with spinal diseases and treatment. It is not uncommon to see many people without any formal training in the treatment of spinal diseases commenting only on the negative side of the courses and consequences of treatment of spinal diseases and thereby frightening away the patient from the necessary intervention. On the other hand, the population in general is largely unaware on essential information like when to see a spinal surgeon. This short write-up will address this topic to avoid delays and disappointments in treatment of spinal disorders in cases of most common conditions. It must be remembered that this does not encompasses the entire spectrum of referral to the spinal surgeon. Routine medical jargons and challenging discussions are intentionally avoided.
1. Injury
Any injury to the spine must be dealt with by urgent radiological investigation and consultation with a spinal surgeon. Some signs of spinal injury but not limited to are pain, inability to walk or stand, difficulty or inability to move the neck / upper or lower back, decreased / altered sensation in the limbs, weakness of muscles, respiratory difficulty, loss of bladder-bowel control etc. In case of any of the symptoms, the patient should be taken to the nearest health facility in a hard stretcher (can be put in a car) with the neck immobilized without movement.
Summary: Any injury to the spine - rush to the spinal surgeons.
2. Infection
Infection in the spine can happen to anyone or in any part of the spine but more commonly in the elderly or immunocompromised individuals (malnourished, uncontrolled diabetes mellitus, organ transplant recipients, HIV, intravenous drug abusers, chronic diseases like cancer or rheumatoid arthritis, or long-term steroid users). The common symptoms are pain and spasm in the back or neck with limited movement with or without weakness of the limbs, night sweats, and sometimes fever. It is important to note that although common, fever might be absent in spinal infection especially in the elderly and immunocompromised.
Summary: Any spontaneous onset pain in the spine with spasm – rush to the spinal surgeons.
3. Cauda Equina Syndrome (CES)
This refers to back pain with both leg pain, loss of sensation in the saddle (perineal) area, loss of bladder control, weakness of the ankle, toes, knee or hip etc. Usually caused by a slipped disc in younger people, but could also be due to tumour, infection, trauma, or lumbar canal stenosis. It is treated with spinal decompression surgery usually within 24 hours.
Summary: Back pain with leg pain and bladder loss requires emergency consultation and MRI to rule out CES.
4. Cervical Myelopathy
This means compression on the cervical spinal cord. The spinal cord’s limited capacity to heal makes this condition progressive if untreated. Common symptoms are neck pain, tingling, hand dysfunction, walking instability, and bladder control loss. Early surgical intervention can stop deterioration, though not always reverse it.
Summary: Chronic spinal cord compression (injury) must be dealt with expeditiously.
5. Cervical Radiculopathy
Compression of the nerve roots in the neck causing pain, tingling, and weakness. Often due to a slipped disc, though infection or tumour can cause similar symptoms. While most recover non-surgically, proper imaging is essential to confirm the cause.
Summary: Neck and arm pain, tingling, or weakness must be dealt with promptly.
6. Lumbar Radiculopathy
Similar to cervical radiculopathy but affecting the lower back and legs. Commonly caused by lumbar disc prolapse. Surgery may be required if symptoms persist beyond 6 months or CES develops. Delay may reduce the chance of full recovery.
Summary: Low back and leg pain, tingling, or weakness must be dealt with expeditiously.
7. Cancer History
Constant back or neck pain with a history of cancer should be evaluated immediately, as metastasis to the spine is possible and must be diagnosed early for effective management.
Summary: Back or neck pain with history of cancer must be dealt with urgently.
8. Spinal Deformity
Spinal deformity, especially in children or those with neuromuscular conditions, can lead to severe complications if untreated. Early intervention minimizes surgical complexity and risk. Adult spinal deformities can severely affect quality of life, comparable to chronic diseases.
Summary: Early evaluation of spinal deformity reduces future complications.
