Cauda equina syndrome  

spine emergency

Classically defined as urinary retention, saddle anesthesia of the perineum, bilateral lower extremity pain, numbness, and weakness

Decreased rectal tone may be a relatively late finding

Suspected infection

discitis-osteomyelitis

Risk factors include immunosupression or IV drug use

• fever may only present in 1/3 of patients
• pain is often severe and insidious in onset
• pain is usually unrelenting  and worse with activity
• pain that awakens patients at night should raise concern for infection

Suspected epidural abscess

Risk factors include immunosupression or IV drug use

• relentless spinal pain is the most common presenting complaint
• neurological findings are absent in the majority of early presentations
• fever present in 60% to 70% of otherwise healthy individuals

Suspected epidural hematoma

Risk factors include trauma, recent spinal procedures, and coagulopathy

May present with acute pain but no neurological symptoms

Suspected cancer

Past history of cancer

• pain is often severe and insidious in onset
• pain is usually unrelenting  and worse with activity
• pain that awakens patients at night should raise concern for malignancy

Suspected compression fracture

Risk factors include trauma and osteoporosis

Severe or progressive neurologic deficit

Defined and reproducible motor or sensory deficit

this does not include isolated neuropathic pain or paresthesia