HWN Suggests

Episode 26: Low Back Pain Emergencies

Spinal metastases are one of the most common causes of cord compression. Pre-treatment neuro status predicts outcome for this emergency...

Give dexamethasone as soon as mets are suspected (at least 10mg IV) if the patient has neurologic symptoms. Consider bisphosphonate and calcitonin if patient is hypercalcemic, or if you suspect compression # or bony metastasis.

Get an urgent MRI if there are symptoms of cord compression. If there are hard neurologic findings, MRI is needed within 24 hours. If the x-ray findings are consistent with mets, but there are no neuro findings, an MRI should be done within 7 days.

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Articles of Interest

EM@3AM: Back Pain

When there are “red flag findings” concerning for spinal cord / ligamentous involvement, neurologic compromise, cancer/metastasis, or infectious spread: MRI without contrast is the best initial examination.

Spinal Cord Compression

Acute spinal cord compression is caused by any pathology that leads to compression of the spinal cord. Metastatic spinal cord compression (MSCC) is the most common aetiology, however there are a wide range of causes...

Spinal cord compression (non-traumatic)

Most often from cancer. Multiple myeloma, lymphoma, prostate, lung, breast. Site of Compression: Thoracic > Cervical > Lumbar

Spinal cord compression in the emergency department: Using a diagnostic-therapeutic algorithm

Malignant spinal cord compression is a medical emergency. Along with superior vena cava compression syndrome, spinal cord compression numbers among the most common oncologic emergencies.

Spinal Cord Compression: Evaluation and Management

Spinal cord compression is an emergency. Delay in treatment can lead to permanent deficits. However, the diagnosis can be difficult. There are many patients with low back pain who seek care in an emergency department, yet few of them will have this complication.

The reliability of red flags in spinal cord compression

The predictive value of the two statistically significant red flags only marginally raises the clinical suspicion of spinal cord or cauda equina compression. Effective risk stratification of patients presenting to the ED with acute back pain is crucial; however, this study did not support the use of these red flags in their current form.

Time is Brain, Time is Testicle, Time is…Spine?

Cervical myelopathy is a syndrome of spinal cord dysfunction caused by compression of the spinal cord. Cervical myelopathy is most commonly caused by degenerative disease of the spine (spondylosis), but other etiologies include mass effect (tumor or abscess), trauma, ossification of the posterior longitudinal ligament (OPLL), and congenital stenosis. It most commonly affects individuals over the age of 50.

Resources

OzEMedicine

65% thoracic, 20% lumbosacral spine, 15% cervical. May be first sign of neoplasm/ complicate pre-existing disease.

StatPearls

Spinal cord compression can result from a myriad of both atraumatic and traumatic causes. The spinal column is vulnerable to a variety of compressive phenomena, such as the expansion of blood products, neoplastic disease, infectious collections, or protrusion of bone or intervertebral disc within the limited area of the fat-filled spinal epidural space and meninges.