🕷️ Crawler Inspector

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Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 151 (from laksa029)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa151.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency","crawl_time":1776298577,"first_indexed_time":1615059464,"http_code":200,"src_unparsed":"com,spine-health!www,\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency s443","src_root_hash":"12565626164814078751","history_drop_reason":null,"meta_title":"When Back Pain May Be a Medical Emergency","meta_descriptions":["Back pain accompanied by severe neurological symptoms and loss of bowel\/bladder control is a medical emergency."],"attrs_boilerpipe_text":"The underlying causes for most occurrences of back pain are non-emergent, but the intense pain and related symptoms often elevate anxiety and prompt a visit to the emergency room (ER). While back pain is typically treated in a primary care setting or by a musculoskeletal specialist, physicians are often cautious and look for warning signs of neurologically impairing or life-threatening causes. These causes are rare, but if present, they are considered a medical emergency and warrant immediate treatment to preserve back and\/or leg function.\nBack pain is considered the most common musculoskeletal cause for emergency room visits and typically involves individuals aged 18 to 65 years.\n1\nCorwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi:\n10.1016\/j.emc.2010.06.001\n,\n2\nPakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi:\n10.2214\/AJR.19.21674\nThis article provides a comprehensive guide to when back pain may indicate a medical emergency and the associated red-flag symptoms to watch out for.\nIn This Article:\nWhen an Emergency Room Visit Is Warranted for Back Pain\nWhen dealing with severe back pain, making a judgment call about whether to seek help in a doctor’s office or visit the ER may be difficult.\nThe following list describes the symptoms and signs related to conditions that may have resulted in spinal cord, cauda equina, or internal organ damage, which are typically considered as a medical emergency.\nAbdominal aortic aneurysm\nLower back pain that radiates to the front abdomen may occur together in a rare, serious medical condition called\nabdominal aortic aneurysm\n. Classic symptoms include:\nA continuous, stabbing pain of severe intensity felt deep in the abdomen between the sternum in the center of the chest and the belly button.\nLower back pain, which may also spread to the groin, pelvis, and\/or legs.\nA pulsating mass in the abdomen, which may be felt through the skin and is sensitive to touch.\nSudden and rapid heartbeat, shallow breathing, clammy skin and cold sweats, general weakness, confusion, anxiety, and\/or loss of consciousness, indicating shock.\nAbdominal aneurysms are more prevalent among men aged 65 to 75 years who smoke cigarettes.\n3\nFact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\nSee\nAbdominal Aortic Aneurysm Causes\nCauda equina syndrome\nDamage to the cauda equina nerves can cause\ncauda equina syndrome\n, a condition that results in severe impairments in the lower back and leg(s). The hallmark symptoms of this condition include:\nDifficulty or inability to control bowel movements with sensory loss and decreased sphincter tone in the anal region\n4\nKim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.\n,\n5\nFairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68.\ndoi:10.3399\/bjgp14X676988\nDifficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, and\/or a poor stream\n4\nKim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.\n,\n5\nFairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68.\ndoi:10.3399\/bjgp14X676988\nNumbness in the groin, buttocks, genitals, and\/or inner thighs (saddle numbness)\n3\nFact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\nSexual dysfunction\n5\nFairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68.\ndoi:10.3399\/bjgp14X676988\n,\n6\nVerdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:\n10.1016\/b978-141603618-0.10020-7\nCauda equina syndrome may occur as a result of acute trauma or develop without an inciting event, due to the progression of an underlying condition. These conditions may include a\nlumbar herniated disc\n,\nlumbar spinal stenosis\n, or\nspinal tumor\nthat affects the cauda equina nerves.\nRead more about\nCauses of Cauda Equina Syndrome\nSpinal tumor\nBenign or metastatic spine tumors may cause back pain as the first symptom. Over time, they are typically accompanied by other distinguishing symptoms, such as:\nUnrelenting pain despite rest and medication\nFever and chills\nNight pain\nNight sweats\nProgressive or sudden motor weakness in the leg(s)\nUnexplained weight loss\nTumors can originate in the spine or spread to the spine from other parts of the body, in which case they are more likely to lodge in the vertebrae because of the spine’s extensive network of blood vessels. The back and leg symptoms are typically dictated by the location of the tumor in the spine.\nSee\nCould My Back Pain Be Spine Cancer?\nSpinal infection\nHarmful microorganisms can travel to the spine from other parts of the body where infection exists. The resulting\nspinal infection, called vertebral osteomyelitis\n, can result in back pain. The symptoms of a spinal infection are variable and depend on the age of the patient, the severity of the infection, and the location in the spine. In addition to back pain, spinal infection symptoms may include some combination of the following:\nFever with chills\nPain that is worse at night\nSwelling and possible warmth and redness around the infection site\nUnexplained weight loss\nA spinal infection may move into the spinal canal and cause an epidural abscess, which can place pressure on the neural elements, such as the spinal cord, cauda equina, and\/or spinal nerve roots. Depending on the level of infection and\/or the degree of severity, sciatica-like symptoms, such as numbness, weakness, or paralysis, may occur in the areas of the body below the affected site.\nSee\nOsteomyelitis Treatments\nAcute trauma\nBack pain that occurs immediately after acute trauma to the upper or lower back prompts urgent evaluation. Examples of acute trauma include sudden injuries from events like a slip, fall, playing active sports, or motor vehicle accident.\nModerate to severe back pain may develop as the only symptom or may occur in tandem with neurological symptoms, such as:\nLeg pain and numbness\nInability to lift the foot (foot drop)\nComplete loss of sensation in one or both legs indicating paralysis\nInjuries from acute trauma to the back can result in a\nspinal fracture\nor severe\nspondylolisthesis\n, which can compress or injure the spinal cord and\/or cauda equina at the level involved. If an underlying bone-weakening condition, such as osteoporosis, exists, even mild trauma may cause compression fractures in the spine.\nWho May Be Prone to Back Pain from Medical Emergencies\nWhile a serious medical condition can affect anyone, some individuals are more prone to these problems due to their underlying health conditions, physical characteristics, and lifestyle habits.\nThis list outlines the groups of people most prone to back pain from medical emergencies:\nThe young and the elderly.\nThe age of the individual is an important initial consideration when diagnosing back pain. Those less than 18 years or more than 50 years of age are typically at a higher likelihood of serious conditions as the cause for the back pain and typically need immediate care when symptoms occur.\nTumors and infection occur with higher frequency in both these age groups.\n1\nCorwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi:\n10.1016\/j.emc.2010.06.001\nYounger individuals are at increased risk of spondylolysis and spondylolisthesis.1 If these conditions are severe, they can affect the neural elements of the spine, causing pain and disability.\nElderly individuals are more susceptible to abdominal aortic aneurysm.\n3\nFact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\nOlder individuals may sustain fractures, including pathologic fractures, even with minor trauma.\n1\nCorwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi:\n10.1016\/j.emc.2010.06.001\nThe immunocompromised.\nReduced immunity or a weakened immune system can make individuals susceptible to specific spinal conditions. Examples of the various causes of reduced immunity and the resultant back pain conditions that are likely to occur are outlined below\n1\nCorwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi:\n10.1016\/j.emc.2010.06.001\n:\nA history of intravenous drug abuse, and\/or recent bacterial infection, such as pneumonia or urinary tract infection, may pose an increased risk for spinal infection.\nChronic steroid use and\/or a history of cancer are linked to an increased risk for a spinal fracture, even from minor trauma.\nCancer in another part of the body, especially in the breast, lung, or prostate, can metastasize in the spine, which is the third most common site for metastatic tumors.\nAs a general rule, any concerning symptom or sign needs to be evaluated by a medical professional. A trained medical professional can adequately evaluate the vital signs, prescribe the necessary diagnostic tests, identify potential neurologic defects, and uncover any red flags. Physicians can also provide timely treatment to prevent the progression of the condition, avoiding permanent damage to the tissues.\n1\nCorwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi:\n10.1016\/j.emc.2010.06.001\n2\nPakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi:\n10.2214\/AJR.19.21674\n3\nFact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n4\nKim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.\n5\nFairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68.\ndoi:10.3399\/bjgp14X676988\n6\nVerdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:\n10.1016\/b978-141603618-0.10020-7\nNext Page:\nBack Pain Red-Flags for Emergency Room vs. Physician Consults\nPages:\n1\n2\nDr. Ari Ben-Yishay is a retired orthopedic surgeon who had more than 25 years of experience specializing in surgical and non-surgical spine care.\nEditor’s Top Picks\nWhen Sciatica Pain Is a Medical Emergency\nCauda Equina Syndrome Video\n2 Sciatica Symptoms That Require Immediate Medical Attention\nPiriformis Syndrome: When the Symptoms Indicate a Medical Emergency\nCauses of Cauda Equina Syndrome\nMetastatic Spinal Cancer Video","attrs_markdown":"[Skip to main content](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#main-content)\n\n[Spine-health Home ![](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/fl_sanitize\/c_fill,g_west,h_50,w_270\/spine-health-horizontal-color.svg?_a=BAAAV6E0)](https:\/\/www.spine-health.com\/)   [Subscribe](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency)\n\n- [Conditions](https:\/\/www.spine-health.com\/conditions)\n  - Back\n  - [Arthritis](https:\/\/www.spine-health.com\/conditions\/arthritis)\n  - [Chronic Pain](https:\/\/www.spine-health.com\/conditions\/chronic-pain)\n  - [Degenerative Disc Disease](https:\/\/www.spine-health.com\/conditions\/degenerative-disc-disease)\n  - [Herniated Disc](https:\/\/www.spine-health.com\/conditions\/herniated-disc)\n  - [Lower Back Pain](https:\/\/www.spine-health.com\/conditions\/lower-back-pain)\n  - [Neck Pain](https:\/\/www.spine-health.com\/conditions\/neck-pain)\n  - [Osteoporosis](https:\/\/www.spine-health.com\/conditions\/osteoporosis)\n  - [Sciatica](https:\/\/www.spine-health.com\/conditions\/sciatica)\n  - [Spinal Stenosis](https:\/\/www.spine-health.com\/conditions\/spinal-stenosis)\n  - [All Conditions](https:\/\/www.spine-health.com\/conditions)\n- [Treatment](https:\/\/www.spine-health.com\/treatment)\n  - Back\n  - [Alternative Care](https:\/\/www.spine-health.com\/treatment\/alternative-care)\n  - [Artificial Disc Replacement](https:\/\/www.spine-health.com\/treatment\/artificial-disc-replacement)\n  - [Back Surgery](https:\/\/www.spine-health.com\/treatment\/back-surgery)\n  - [Chiropractic](https:\/\/www.spine-health.com\/treatment\/chiropractic)\n  - [Injections](https:\/\/www.spine-health.com\/treatment\/injections)\n  - [Pain Management](https:\/\/www.spine-health.com\/treatment\/pain-management)\n  - [Pain Medication](https:\/\/www.spine-health.com\/treatment\/pain-medication)\n  - [Physical Therapy](https:\/\/www.spine-health.com\/treatment\/physical-therapy)\n  - [Spinal Fusion](https:\/\/www.spine-health.com\/treatment\/spinal-fusion)\n  - [All Treatments](https:\/\/www.spine-health.com\/treatment)\n- [Wellness](https:\/\/www.spine-health.com\/wellness)\n  - Back\n  - [Ergonomics](https:\/\/www.spine-health.com\/wellness\/ergonomics)\n  - [Exercise](https:\/\/www.spine-health.com\/wellness\/exercise)\n  - [Massage Therapy](https:\/\/www.spine-health.com\/wellness\/massage-therapy)\n  - [Nutrition, Diet, and Weight Loss](https:\/\/www.spine-health.com\/wellness\/nutrition-diet-weight-loss)\n  - [Sleep](https:\/\/www.spine-health.com\/wellness\/sleep)\n  - [Stop Smoking](https:\/\/www.spine-health.com\/wellness\/stop-smoking)\n  - [All Wellness](https:\/\/www.spine-health.com\/wellness)\n- [Videos](https:\/\/www.spine-health.com\/video)\n- [Shop](https:\/\/www.spine-health.com\/shop)\n\nBack\n\n1. [Home](https:\/\/www.spine-health.com\/)\n2. [Conditions](https:\/\/www.spine-health.com\/conditions)\n3. [Lower Back Pain](https:\/\/www.spine-health.com\/conditions\/lower-back-pain)\n4. [When Back Pain May Be a Medical Emergency](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency)\n# When Back Pain May Be a Medical Emergency\nBy: [Ari Ben-Yishay, MD, Orthopedic Surgeon](https:\/\/www.spine-health.com\/author\/ari-ben-yishay-md)\n\n[Peer-Reviewed](https:\/\/www.veritashealth.com\/editorial-process)\n\nThe underlying causes for most occurrences of back pain are non-emergent, but the intense pain and related symptoms often elevate anxiety and prompt a visit to the emergency room (ER). While back pain is typically treated in a primary care setting or by a musculoskeletal specialist, physicians are often cautious and look for warning signs of neurologically impairing or life-threatening causes. These causes are rare, but if present, they are considered a medical emergency and warrant immediate treatment to preserve back and\/or leg function.\n\nBack pain is considered the most common musculoskeletal cause for emergency room visits and typically involves individuals aged 18 to 65 years.[1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub),[2](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote2)Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: [10\\.2214\/AJR.19.21674](https:\/\/doi.org\/10.2214\/ajr.19.21674)\n\nThis article provides a comprehensive guide to when back pain may indicate a medical emergency and the associated red-flag symptoms to watch out for.\n\nIn This Article:\n\n- When Back Pain May Be a Medical Emergency\n- [Back Pain Red-Flags for Emergency Room vs. Physician Consults](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/back-pain-red-flags-emergency-room-vs-physician-consults)\n\n## When an Emergency Room Visit Is Warranted for Back Pain\nWhen dealing with severe back pain, making a judgment call about whether to seek help in a doctor’s office or visit the ER may be difficult.\n\nThe following list describes the symptoms and signs related to conditions that may have resulted in spinal cord, cauda equina, or internal organ damage, which are typically considered as a medical emergency.\n\n### Abdominal aortic aneurysm\n\n![An illustration showing blood supply in the pelvic region.](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/c_fill,g_center,h_439,w_780\/q_auto:eco\/sciatic-nerve-blood-supply-noheader.png?_a=BAAAV6E0)\n\nSave\n\n*Rupture of the abdominal aorta is a serious medical condition.*\n\nLower back pain that radiates to the front abdomen may occur together in a rare, serious medical condition called [abdominal aortic aneurysm](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/abdominal-aortic-aneurysm \"Abdominal Aortic Aneurysm\"). Classic symptoms include:\n\n- A continuous, stabbing pain of severe intensity felt deep in the abdomen between the sternum in the center of the chest and the belly button.\n- Lower back pain, which may also spread to the groin, pelvis, and\/or legs.\n- A pulsating mass in the abdomen, which may be felt through the skin and is sensitive to touch.\n- Sudden and rapid heartbeat, shallow breathing, clammy skin and cold sweats, general weakness, confusion, anxiety, and\/or loss of consciousness, indicating shock.\n\nAbdominal aneurysms are more prevalent among men aged 65 to 75 years who smoke cigarettes.[3](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n\nSee [Abdominal Aortic Aneurysm Causes](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/abdominal-aortic-aneurysm-causes \"Abdominal Aortic Aneurysm Causes \")\n\n### Cauda equina syndrome\n\n[Skip to video transcript](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#transcript-jwplayer-container-TQcVeEUW)\n\nCauda Equina Syndrome Video\n\n0 seconds of 1 minute, 59 secondsVolume 90%\n\nPress shift question mark to access a list of keyboard shortcuts\n\nKeyboard Shortcuts\n\nEnabledDisabled\n\nShortcuts Open\/Close\/ or ?\n\nPlay\/PauseSPACE\n\nIncrease Volume↑\n\nDecrease Volume↓\n\nSeek Forward→\n\nSeek Backward←\n\nCaptions On\/Offc\n\nFullscreen\/Exit Fullscreenf\n\nMute\/Unmutem\n\nDecrease Caption Size\\-\n\nIncrease Caption Size\\+ or =\n\nSeek %0-9\n\nNext Up\n\n6 Overlooked Remedies for Lower Back Pain Relief Video\n\n04:41\n\nSubtitle Settings\n\nOff\n\nEnglish\n\nFont Color\n\nWhite\n\nFont Opacity\n\n100%\n\nFont Size\n\n100%\n\nFont Family\n\nsans-serif\n\nCharacter Edge\n\nNone\n\nEdge Color\n\nBlack\n\nBackground Color\n\nBlack\n\nBackground Opacity\n\n75%\n\nWindow Color\n\nBlack\n\nWindow Opacity\n\n0%\n\nReset\n\nWhite\n\nBlack\n\nRed\n\nGreen\n\nBlue\n\nYellow\n\nMagenta\n\nCyan\n\n100%\n\n75%\n\n50%\n\n25%\n\n200%\n\n175%\n\n150%\n\n125%\n\n100%\n\n75%\n\n50%\n\nArial\n\nCourier\n\nGeorgia\n\nImpact\n\nLucida Console\n\nTahoma\n\nTimes New Roman\n\nTrebuchet MS\n\nVerdana\n\nNone\n\nRaised\n\nDepressed\n\nUniform\n\nDrop Shadow\n\nWhite\n\nBlack\n\nRed\n\nGreen\n\nBlue\n\nYellow\n\nMagenta\n\nCyan\n\nWhite\n\nBlack\n\nRed\n\nGreen\n\nBlue\n\nYellow\n\nMagenta\n\nCyan\n\n100%\n\n75%\n\n50%\n\n25%\n\n0%\n\nWhite\n\nBlack\n\nRed\n\nGreen\n\nBlue\n\nYellow\n\nMagenta\n\nCyan\n\n100%\n\n75%\n\n50%\n\n25%\n\n0%\n\nfacebook\n\nx\n\nEmail\n\npinterest\n\nLink\n\nhttps:\/\/www.spine-health.com\/video\/cauda-equina-syndrome-video\n\nCopied\n\nAuto270p\n\n720p\n\n406p\n\n270p\n\n180p\n\nLive\n\n00:00\n\n01:59\n\n01:59\n\nMore Videos\n\n04:41\n\n6 Overlooked Remedies for Lower Back Pain Relief Video\n\n01:10\n\nLumbar Herniated Disc Video\n\n05:02\n\nLower Back Pain Treatment Video\n\n03:06\n\nLower Back Pain Causes and Symptoms Video\n\n01:28\n\nLower Back Strain Video\n\n00:50\n\nLumbar Spinal Stenosis Video\n\n01:17\n\nCoccydynia (Tailbone Pain) Video\n\n03:42\n\nLower Back Muscle Strain or Sprain Video\n\nClose\n\nSave\n\nWatch [Cauda Equina Syndrome Video](https:\/\/www.spine-health.com\/video\/cauda-equina-syndrome-video)\n\nShow Transcript\n\nDamage to the cauda equina nerves can cause [cauda equina syndrome](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/cauda-equina-syndrome \"Cauda Equina Syndrome\"), a condition that results in severe impairments in the lower back and leg(s). The hallmark symptoms of this condition include:\n\n- Difficulty or inability to control bowel movements with sensory loss and decreased sphincter tone in the anal region[4](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote4)Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.,[5](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399\/bjgp14X676988](https:\/\/bjgp.org\/content\/64\/619\/67)\n- Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, and\/or a poor stream[4](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote4)Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.,[5](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399\/bjgp14X676988](https:\/\/bjgp.org\/content\/64\/619\/67)\n- Numbness in the groin, buttocks, genitals, and\/or inner thighs (saddle numbness)[3](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n- Sexual dysfunction[5](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399\/bjgp14X676988](https:\/\/bjgp.org\/content\/64\/619\/67),[6](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote6)Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:[10\\.1016\/b978-141603618-0.10020-7](https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9781416036180100207?via%3Dihub)\n\nCauda equina syndrome may occur as a result of acute trauma or develop without an inciting event, due to the progression of an underlying condition. These conditions may include a [lumbar herniated disc](https:\/\/www.spine-health.com\/conditions\/herniated-disc\/lumbar-herniated-disc \"Lumbar Herniated Disc: What You Should Know\"), [lumbar spinal stenosis](https:\/\/www.spine-health.com\/conditions\/spinal-stenosis\/lumbar-spinal-stenosis \"Lumbar Spinal Stenosis\"), or [spinal tumor](https:\/\/www.spine-health.com\/conditions\/spinal-tumor\/symptoms-a-spinal-tumor \"Symptoms of a Spinal Tumor\") that affects the cauda equina nerves.\n\nRead more about [Causes of Cauda Equina Syndrome](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/causes-cauda-equina-syndrome \"Causes of Cauda Equina Syndrome\")\n\nadvertisement\n\n### Spinal tumor\n![An illustration showing tumor in the spine.](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/c_fill,g_center,h_439,w_780\/q_auto:eco\/adult-spine-bone-tumor.png?_a=BAAAV6E0)\n\nSave\n\n*Spinal tumors may cause neurologic complications.*\n\nBenign or metastatic spine tumors may cause back pain as the first symptom. Over time, they are typically accompanied by other distinguishing symptoms, such as:\n\n- Unrelenting pain despite rest and medication\n- Fever and chills\n- Night pain\n- Night sweats\n- Progressive or sudden motor weakness in the leg(s)\n- Unexplained weight loss\n\nTumors can originate in the spine or spread to the spine from other parts of the body, in which case they are more likely to lodge in the vertebrae because of the spine’s extensive network of blood vessels. The back and leg symptoms are typically dictated by the location of the tumor in the spine.\n\nSee [Could My Back Pain Be Spine Cancer?](https:\/\/www.spine-health.com\/conditions\/spinal-tumor\/could-my-back-pain-be-spine-cancer \"Could My Back Pain Be Spine Cancer?\")\n\n### Spinal infection\n\n![An illustration showing an adult lower body with one leg highlighted in pink.](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/c_fill,g_center,h_439,w_780\/q_auto:eco\/sciatica-radiating-pain.png?_a=BAAAV6E0)\n\nSave\n\n*Spinal infection may cause sciatica-like symptoms.*\n\nHarmful microorganisms can travel to the spine from other parts of the body where infection exists. The resulting [spinal infection, called vertebral osteomyelitis](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/osteomyelitis-a-spinal-infection), can result in back pain. The symptoms of a spinal infection are variable and depend on the age of the patient, the severity of the infection, and the location in the spine. In addition to back pain, spinal infection symptoms may include some combination of the following:\n\n- Fever with chills\n- Pain that is worse at night\n- Swelling and possible warmth and redness around the infection site\n- Unexplained weight loss\n\nA spinal infection may move into the spinal canal and cause an epidural abscess, which can place pressure on the neural elements, such as the spinal cord, cauda equina, and\/or spinal nerve roots. Depending on the level of infection and\/or the degree of severity, sciatica-like symptoms, such as numbness, weakness, or paralysis, may occur in the areas of the body below the affected site.\n\nSee [Osteomyelitis Treatments](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/osteomyelitis-treatments \"Osteomyelitis Treatments\")\n\n### Acute trauma\n\n![An illustration of an adult foot showing foot drop.](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/c_fill,g_center,h_439,w_780\/q_auto:eco\/foot-drop.png?_a=BAAAV6E0)\n\nSave\n\n*Back trauma may result in foot weakness, numbness, and functional loss.*\n\nBack pain that occurs immediately after acute trauma to the upper or lower back prompts urgent evaluation. Examples of acute trauma include sudden injuries from events like a slip, fall, playing active sports, or motor vehicle accident.\n\nModerate to severe back pain may develop as the only symptom or may occur in tandem with neurological symptoms, such as:\n\n- Leg pain and numbness\n- Inability to lift the foot (foot drop)\n- Complete loss of sensation in one or both legs indicating paralysis\n\nInjuries from acute trauma to the back can result in a [spinal fracture](https:\/\/www.spine-health.com\/conditions\/osteoporosis\/when-back-pain-a-spine-compression-fracture \"When Back Pain Is a Spine Compression Fracture\") or severe [spondylolisthesis](https:\/\/www.spine-health.com\/conditions\/spondylolisthesis\/spondylolysis-and-spondylolisthesis \"Spondylolysis and Spondylolisthesis\"), which can compress or injure the spinal cord and\/or cauda equina at the level involved. If an underlying bone-weakening condition, such as osteoporosis, exists, even mild trauma may cause compression fractures in the spine.\n\nadvertisement\n\n## Who May Be Prone to Back Pain from Medical Emergencies\n![An illustration showing people of different age group.](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/c_fill,g_center,h_439,w_780\/q_auto:eco\/family-snow-vacation-illustrated.png?_a=BAAAV6E0)\n\nSave\n\n*Individuals below 18 years and over 50 years of age are typically at a higher likelihood of serious back conditions.*\n\nWhile a serious medical condition can affect anyone, some individuals are more prone to these problems due to their underlying health conditions, physical characteristics, and lifestyle habits.\n\nThis list outlines the groups of people most prone to back pain from medical emergencies:\n\n- **The young and the elderly.** The age of the individual is an important initial consideration when diagnosing back pain. Those less than 18 years or more than 50 years of age are typically at a higher likelihood of serious conditions as the cause for the back pain and typically need immediate care when symptoms occur.\n  - Tumors and infection occur with higher frequency in both these age groups.[1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub)\n  - Younger individuals are at increased risk of spondylolysis and spondylolisthesis.1 If these conditions are severe, they can affect the neural elements of the spine, causing pain and disability.\n  - Elderly individuals are more susceptible to abdominal aortic aneurysm.[3](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n  - Older individuals may sustain fractures, including pathologic fractures, even with minor trauma.[1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub)\n- **The immunocompromised.** Reduced immunity or a weakened immune system can make individuals susceptible to specific spinal conditions. Examples of the various causes of reduced immunity and the resultant back pain conditions that are likely to occur are outlined below[1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub):\n  - A history of intravenous drug abuse, and\/or recent bacterial infection, such as pneumonia or urinary tract infection, may pose an increased risk for spinal infection.\n  - Chronic steroid use and\/or a history of cancer are linked to an increased risk for a spinal fracture, even from minor trauma.\n  - Cancer in another part of the body, especially in the breast, lung, or prostate, can metastasize in the spine, which is the third most common site for metastatic tumors.\n\nAs a general rule, any concerning symptom or sign needs to be evaluated by a medical professional. A trained medical professional can adequately evaluate the vital signs, prescribe the necessary diagnostic tests, identify potential neurologic defects, and uncover any red flags. Physicians can also provide timely treatment to prevent the progression of the condition, avoiding permanent damage to the tissues.\n\nReferences\n\n- [1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref1_FjeB-P2E7GsjWKtDHJEn0j6-JIzLGfx-eJYkGRUdAA_le7KleJpNIaA) Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub)\n- [2](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref2_r36l61-gkin1T7VGDkDqVk7a80yCeWAwXOri4oDUkw_dym7Kzricu65) Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: [10\\.2214\/AJR.19.21674](https:\/\/doi.org\/10.2214\/ajr.19.21674)\n- [3](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref3_cvrQBIo2jYdrd9RGMRn448gzkB1W18ut0nG6L0ozl4_rfaZ68T1WI38) Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n- [4](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref4_QPxsUPG4l7Uput2GXvLdk53Ewo3o68Kg7yTf7MN-dg_p15CMYj7qawB) Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.\n- [5](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref5_YKiAn9cyTscUTvo-mIxFbOkCtt2zKwh5qPWIi0b278_zg60JZffslbt) Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399\/bjgp14X676988](https:\/\/bjgp.org\/content\/64\/619\/67)\n- [6](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref6_ew4155PxQC-J8yZPCAjK1RAO07eyWCRD-lxH2ThwM0_mbPODZiufAG6) Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:[10\\.1016\/b978-141603618-0.10020-7](https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9781416036180100207?via%3Dihub)\n\n[Get our FREE Guide to Natural Back Pain Relief](https:\/\/www.spine-health.com\/newsletter?offer=GUIDE-NaturalBackPainRelief)\n\n## Pagination\nNext Page:  [Back Pain Red-Flags for Emergency Room vs. Physician Consults](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/back-pain-red-flags-emergency-room-vs-physician-consults)\n\nPages:\n\n- 1\n- [2](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/back-pain-red-flags-emergency-room-vs-physician-consults)\n\n[![Ari Ben-Yishay](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/c_fill,g_north,h_120,w_120\/q_auto:eco\/ari-ben-yishay.jpeg?_a=BAAAV6E0)](https:\/\/www.spine-health.com\/author\/ari-ben-yishay-md)\n\nDr. Ari Ben-Yishay is a retired orthopedic surgeon who had more than 25 years of experience specializing in surgical and non-surgical spine care.\n\n- [Share on Facebook](https:\/\/www.facebook.com\/sharer.php?u=&t=)\n- [Share on Pinterest](http:\/\/pinterest.com\/pin\/create\/link\/?url=&description=)\n- [Subscribe to our newsletter](https:\/\/www.spine-health.com\/newsletter)\n- Print this article\n- [Email this article](mailto:?body=%26subject=&body=&subject=)\n\nadvertisement\n\n## Editor’s Top Picks\n- [When Sciatica Pain Is a Medical Emergency](https:\/\/www.spine-health.com\/conditions\/sciatica\/when-sciatica-pain-medical-emergency)\n- [Cauda Equina Syndrome Video](https:\/\/www.spine-health.com\/video\/cauda-equina-syndrome-video)\n- [2 Sciatica Symptoms That Require Immediate Medical Attention](https:\/\/www.spine-health.com\/blog\/2-sciatica-symptoms-require-immediate-medical-attention)\n- [Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency](https:\/\/www.spine-health.com\/conditions\/sciatica\/piriformis-syndrome-when-symptoms-indicate-medical-emergency)\n- [Causes of Cauda Equina Syndrome](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/causes-cauda-equina-syndrome)\n- [Metastatic Spinal Cancer Video](https:\/\/www.spine-health.com\/video\/metastatic-spinal-cancer-video)\n\nadvertisement\n\nadvertisement\n\n## Popular Videos\n[![](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/w_150,h_84,q_80\/lowerbackpaintreatment-35.webp?_a=BAAAV6E0) 5:02 Lower Back Pain Treatment Video](https:\/\/www.spine-health.com\/video\/lower-back-pain-treatment-video)\n\n[![](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/w_150,h_84,q_80\/inflammatory-protein-nerve-contact.webp?_a=BAAAV6E0) 1:45 Herniated Disc Symptoms Animation](https:\/\/www.spine-health.com\/video\/herniated-disc-symptoms-animation)\n\n[![](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/w_150,h_84,q_80\/cervical-degenerative-disc-disease.webp?_a=BAAAV6E0) 1:31 Cervical Degenerative Disc Disease Video](https:\/\/www.spine-health.com\/video\/cervical-degenerative-disc-disease-video)\n\n[![](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/w_150,h_84,q_80\/vid-326.webp?_a=BAAAV6E0) 5:51 McKenzie Method Exercises for Back Pain and Sciatica Video](https:\/\/www.spine-health.com\/video\/mckenzie-method-exercises-back-pain-and-sciatica-video)\n\nPain Evaluation Tool\n\nSponsored by: [Boston Scientific](http:\/\/pubads.g.doubleclick.net\/gampad\/clk?id=6745229490&iu=\/1006215)\n\nYour Pain is Unique\n\nNo one knows your pain better than you. Help us understand what you're experiencing so we can guide you to the right information.\n\n[**Take the Pain Quiz \\>**](http:\/\/pubads.g.doubleclick.net\/gampad\/clk?id=6745229490&iu=\/1006215)\n\nadvertisement\n\n## Health Information (Sponsored)\n- [Learn How Bone Growth Therapy Can Help You](https:\/\/www.spine-health.com\/education-centers\/orthofix\/spinal-fusion-therapy)\n- [See if Spinal Cord Stimulation is Right for You](https:\/\/www.spine-health.com\/education-centers\/boston-scientific\/spinal-cord-stimulation)\n- [Your Lumbar Fusion Recovery Roadmap Starts Here](https:\/\/shop.spine-health.com\/products\/what-happens-after-lumbar-fusion-step-by-step-recovery)\n- [Take the Chronic Pain Quiz](https:\/\/www.spine-health.com\/education-centers\/boston-scientific\/spinal-cord-stimulation)\n\nadvertisement\n\n[Subscribe to the Veritas Health newsletter NOW to get our FREE Guide to Natural Back Pain Relief.](https:\/\/www.spine-health.com\/newsletter?offer=GUIDE-NaturalBackPainRelief)\n\nSubscribe\n\nGet Our FREE Guide\n\nSubscribe to our newsletter and get your FREE guide,   \n*Natural Back Pain Relief: 16 Choices for Lasting Comfort*.\n\nWe respect your privacy. 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The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions.\n\nVeritas Health LLC,   580 N Bank Ln, Lake Forest, IL, 60045, USA","attrs_readable_markdown":"The underlying causes for most occurrences of back pain are non-emergent, but the intense pain and related symptoms often elevate anxiety and prompt a visit to the emergency room (ER). While back pain is typically treated in a primary care setting or by a musculoskeletal specialist, physicians are often cautious and look for warning signs of neurologically impairing or life-threatening causes. These causes are rare, but if present, they are considered a medical emergency and warrant immediate treatment to preserve back and\/or leg function.\n\nBack pain is considered the most common musculoskeletal cause for emergency room visits and typically involves individuals aged 18 to 65 years.[1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub),[2](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote2)Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: [10\\.2214\/AJR.19.21674](https:\/\/doi.org\/10.2214\/ajr.19.21674)\n\nThis article provides a comprehensive guide to when back pain may indicate a medical emergency and the associated red-flag symptoms to watch out for.\n\nIn This Article:\n\n## When an Emergency Room Visit Is Warranted for Back Pain\nWhen dealing with severe back pain, making a judgment call about whether to seek help in a doctor’s office or visit the ER may be difficult.\n\nThe following list describes the symptoms and signs related to conditions that may have resulted in spinal cord, cauda equina, or internal organ damage, which are typically considered as a medical emergency.\n\n### Abdominal aortic aneurysm\n\nLower back pain that radiates to the front abdomen may occur together in a rare, serious medical condition called [abdominal aortic aneurysm](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/abdominal-aortic-aneurysm \"Abdominal Aortic Aneurysm\"). Classic symptoms include:\n\n- A continuous, stabbing pain of severe intensity felt deep in the abdomen between the sternum in the center of the chest and the belly button.\n- Lower back pain, which may also spread to the groin, pelvis, and\/or legs.\n- A pulsating mass in the abdomen, which may be felt through the skin and is sensitive to touch.\n- Sudden and rapid heartbeat, shallow breathing, clammy skin and cold sweats, general weakness, confusion, anxiety, and\/or loss of consciousness, indicating shock.\n\nAbdominal aneurysms are more prevalent among men aged 65 to 75 years who smoke cigarettes.[3](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n\nSee [Abdominal Aortic Aneurysm Causes](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/abdominal-aortic-aneurysm-causes \"Abdominal Aortic Aneurysm Causes \")\n\n### Cauda equina syndrome\n\nDamage to the cauda equina nerves can cause [cauda equina syndrome](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/cauda-equina-syndrome \"Cauda Equina Syndrome\"), a condition that results in severe impairments in the lower back and leg(s). The hallmark symptoms of this condition include:\n\n- Difficulty or inability to control bowel movements with sensory loss and decreased sphincter tone in the anal region[4](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote4)Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.,[5](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399\/bjgp14X676988](https:\/\/bjgp.org\/content\/64\/619\/67)\n- Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, and\/or a poor stream[4](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote4)Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.,[5](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399\/bjgp14X676988](https:\/\/bjgp.org\/content\/64\/619\/67)\n- Numbness in the groin, buttocks, genitals, and\/or inner thighs (saddle numbness)[3](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n- Sexual dysfunction[5](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399\/bjgp14X676988](https:\/\/bjgp.org\/content\/64\/619\/67),[6](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote6)Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:[10\\.1016\/b978-141603618-0.10020-7](https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9781416036180100207?via%3Dihub)\n\nCauda equina syndrome may occur as a result of acute trauma or develop without an inciting event, due to the progression of an underlying condition. These conditions may include a [lumbar herniated disc](https:\/\/www.spine-health.com\/conditions\/herniated-disc\/lumbar-herniated-disc \"Lumbar Herniated Disc: What You Should Know\"), [lumbar spinal stenosis](https:\/\/www.spine-health.com\/conditions\/spinal-stenosis\/lumbar-spinal-stenosis \"Lumbar Spinal Stenosis\"), or [spinal tumor](https:\/\/www.spine-health.com\/conditions\/spinal-tumor\/symptoms-a-spinal-tumor \"Symptoms of a Spinal Tumor\") that affects the cauda equina nerves.\n\nRead more about [Causes of Cauda Equina Syndrome](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/causes-cauda-equina-syndrome \"Causes of Cauda Equina Syndrome\")\n\nSpinal tumor\n\nBenign or metastatic spine tumors may cause back pain as the first symptom. Over time, they are typically accompanied by other distinguishing symptoms, such as:\n\n- Unrelenting pain despite rest and medication\n- Fever and chills\n- Night pain\n- Night sweats\n- Progressive or sudden motor weakness in the leg(s)\n- Unexplained weight loss\n\nTumors can originate in the spine or spread to the spine from other parts of the body, in which case they are more likely to lodge in the vertebrae because of the spine’s extensive network of blood vessels. The back and leg symptoms are typically dictated by the location of the tumor in the spine.\n\nSee [Could My Back Pain Be Spine Cancer?](https:\/\/www.spine-health.com\/conditions\/spinal-tumor\/could-my-back-pain-be-spine-cancer \"Could My Back Pain Be Spine Cancer?\")\n\n### Spinal infection\n\nHarmful microorganisms can travel to the spine from other parts of the body where infection exists. The resulting [spinal infection, called vertebral osteomyelitis](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/osteomyelitis-a-spinal-infection), can result in back pain. The symptoms of a spinal infection are variable and depend on the age of the patient, the severity of the infection, and the location in the spine. In addition to back pain, spinal infection symptoms may include some combination of the following:\n\n- Fever with chills\n- Pain that is worse at night\n- Swelling and possible warmth and redness around the infection site\n- Unexplained weight loss\n\nA spinal infection may move into the spinal canal and cause an epidural abscess, which can place pressure on the neural elements, such as the spinal cord, cauda equina, and\/or spinal nerve roots. Depending on the level of infection and\/or the degree of severity, sciatica-like symptoms, such as numbness, weakness, or paralysis, may occur in the areas of the body below the affected site.\n\nSee [Osteomyelitis Treatments](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/osteomyelitis-treatments \"Osteomyelitis Treatments\")\n\n### Acute trauma\n\nBack pain that occurs immediately after acute trauma to the upper or lower back prompts urgent evaluation. Examples of acute trauma include sudden injuries from events like a slip, fall, playing active sports, or motor vehicle accident.\n\nModerate to severe back pain may develop as the only symptom or may occur in tandem with neurological symptoms, such as:\n\n- Leg pain and numbness\n- Inability to lift the foot (foot drop)\n- Complete loss of sensation in one or both legs indicating paralysis\n\nInjuries from acute trauma to the back can result in a [spinal fracture](https:\/\/www.spine-health.com\/conditions\/osteoporosis\/when-back-pain-a-spine-compression-fracture \"When Back Pain Is a Spine Compression Fracture\") or severe [spondylolisthesis](https:\/\/www.spine-health.com\/conditions\/spondylolisthesis\/spondylolysis-and-spondylolisthesis \"Spondylolysis and Spondylolisthesis\"), which can compress or injure the spinal cord and\/or cauda equina at the level involved. If an underlying bone-weakening condition, such as osteoporosis, exists, even mild trauma may cause compression fractures in the spine.\n\nWho May Be Prone to Back Pain from Medical Emergencies\n\nWhile a serious medical condition can affect anyone, some individuals are more prone to these problems due to their underlying health conditions, physical characteristics, and lifestyle habits.\n\nThis list outlines the groups of people most prone to back pain from medical emergencies:\n\n- **The young and the elderly.** The age of the individual is an important initial consideration when diagnosing back pain. Those less than 18 years or more than 50 years of age are typically at a higher likelihood of serious conditions as the cause for the back pain and typically need immediate care when symptoms occur.\n  - Tumors and infection occur with higher frequency in both these age groups.[1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub)\n  - Younger individuals are at increased risk of spondylolysis and spondylolisthesis.1 If these conditions are severe, they can affect the neural elements of the spine, causing pain and disability.\n  - Elderly individuals are more susceptible to abdominal aortic aneurysm.[3](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n  - Older individuals may sustain fractures, including pathologic fractures, even with minor trauma.[1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub)\n- **The immunocompromised.** Reduced immunity or a weakened immune system can make individuals susceptible to specific spinal conditions. Examples of the various causes of reduced immunity and the resultant back pain conditions that are likely to occur are outlined below[1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub):\n  - A history of intravenous drug abuse, and\/or recent bacterial infection, such as pneumonia or urinary tract infection, may pose an increased risk for spinal infection.\n  - Chronic steroid use and\/or a history of cancer are linked to an increased risk for a spinal fracture, even from minor trauma.\n  - Cancer in another part of the body, especially in the breast, lung, or prostate, can metastasize in the spine, which is the third most common site for metastatic tumors.\n\nAs a general rule, any concerning symptom or sign needs to be evaluated by a medical professional. A trained medical professional can adequately evaluate the vital signs, prescribe the necessary diagnostic tests, identify potential neurologic defects, and uncover any red flags. Physicians can also provide timely treatment to prevent the progression of the condition, avoiding permanent damage to the tissues.\n\n- [1](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref1_FjeB-P2E7GsjWKtDHJEn0j6-JIzLGfx-eJYkGRUdAA_le7KleJpNIaA) Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\\.1016\/j.emc.2010.06.001](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0733862710000465?via%3Dihub)\n- [2](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref2_r36l61-gkin1T7VGDkDqVk7a80yCeWAwXOri4oDUkw_dym7Kzricu65) Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: [10\\.2214\/AJR.19.21674](https:\/\/doi.org\/10.2214\/ajr.19.21674)\n- [3](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref3_cvrQBIo2jYdrd9RGMRn448gzkB1W18ut0nG6L0ozl4_rfaZ68T1WI38) Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021.\n- [4](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref4_QPxsUPG4l7Uput2GXvLdk53Ewo3o68Kg7yTf7MN-dg_p15CMYj7qawB) Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.\n- [5](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref5_YKiAn9cyTscUTvo-mIxFbOkCtt2zKwh5qPWIi0b278_zg60JZffslbt) Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399\/bjgp14X676988](https:\/\/bjgp.org\/content\/64\/619\/67)\n- [6](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/when-back-pain-may-be-medical-emergency#footnoteref6_ew4155PxQC-J8yZPCAjK1RAO07eyWCRD-lxH2ThwM0_mbPODZiufAG6) Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:[10\\.1016\/b978-141603618-0.10020-7](https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9781416036180100207?via%3Dihub)\n\nNext Page:  [Back Pain Red-Flags for Emergency Room vs. Physician Consults](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/back-pain-red-flags-emergency-room-vs-physician-consults)\n\nPages:\n\n- 1\n- [2](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/back-pain-red-flags-emergency-room-vs-physician-consults)\n\n[![Ari Ben-Yishay](https:\/\/res.cloudinary.com\/da1molee1\/image\/upload\/c_fill,g_north,h_120,w_120\/q_auto:eco\/ari-ben-yishay.jpeg?_a=BAAAV6E0)](https:\/\/www.spine-health.com\/author\/ari-ben-yishay-md)\n\nDr. Ari Ben-Yishay is a retired orthopedic surgeon who had more than 25 years of experience specializing in surgical and non-surgical spine care.\n\n## Editor’s Top Picks\n- [When Sciatica Pain Is a Medical Emergency](https:\/\/www.spine-health.com\/conditions\/sciatica\/when-sciatica-pain-medical-emergency)\n- [Cauda Equina Syndrome Video](https:\/\/www.spine-health.com\/video\/cauda-equina-syndrome-video)\n- [2 Sciatica Symptoms That Require Immediate Medical Attention](https:\/\/www.spine-health.com\/blog\/2-sciatica-symptoms-require-immediate-medical-attention)\n- [Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency](https:\/\/www.spine-health.com\/conditions\/sciatica\/piriformis-syndrome-when-symptoms-indicate-medical-emergency)\n- [Causes of Cauda Equina Syndrome](https:\/\/www.spine-health.com\/conditions\/lower-back-pain\/causes-cauda-equina-syndrome)\n- [Metastatic Spinal Cancer Video](https:\/\/www.spine-health.com\/video\/metastatic-spinal-cancer-video)","meta_canonical":null}

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Boilerpipe Text	The underlying causes for most occurrences of back pain are non-emergent, but the intense pain and related symptoms often elevate anxiety and prompt a visit to the emergency room (ER). While back pain is typically treated in a primary care setting or by a musculoskeletal specialist, physicians are often cautious and look for warning signs of neurologically impairing or life-threatening causes. These causes are rare, but if present, they are considered a medical emergency and warrant immediate treatment to preserve back and/or leg function. Back pain is considered the most common musculoskeletal cause for emergency room visits and typically involves individuals aged 18 to 65 years. 1 Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: 10.1016/j.emc.2010.06.001 , 2 Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: 10.2214/AJR.19.21674 This article provides a comprehensive guide to when back pain may indicate a medical emergency and the associated red-flag symptoms to watch out for. In This Article: When an Emergency Room Visit Is Warranted for Back Pain When dealing with severe back pain, making a judgment call about whether to seek help in a doctor’s office or visit the ER may be difficult. The following list describes the symptoms and signs related to conditions that may have resulted in spinal cord, cauda equina, or internal organ damage, which are typically considered as a medical emergency. Abdominal aortic aneurysm Lower back pain that radiates to the front abdomen may occur together in a rare, serious medical condition called abdominal aortic aneurysm . Classic symptoms include: A continuous, stabbing pain of severe intensity felt deep in the abdomen between the sternum in the center of the chest and the belly button. Lower back pain, which may also spread to the groin, pelvis, and/or legs. A pulsating mass in the abdomen, which may be felt through the skin and is sensitive to touch. Sudden and rapid heartbeat, shallow breathing, clammy skin and cold sweats, general weakness, confusion, anxiety, and/or loss of consciousness, indicating shock. Abdominal aneurysms are more prevalent among men aged 65 to 75 years who smoke cigarettes. 3 Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. See Abdominal Aortic Aneurysm Causes Cauda equina syndrome Damage to the cauda equina nerves can cause cauda equina syndrome , a condition that results in severe impairments in the lower back and leg(s). The hallmark symptoms of this condition include: Difficulty or inability to control bowel movements with sensory loss and decreased sphincter tone in the anal region 4 Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. , 5 Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988 Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, and/or a poor stream 4 Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. , 5 Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988 Numbness in the groin, buttocks, genitals, and/or inner thighs (saddle numbness) 3 Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. Sexual dysfunction 5 Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988 , 6 Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi: 10.1016/b978-141603618-0.10020-7 Cauda equina syndrome may occur as a result of acute trauma or develop without an inciting event, due to the progression of an underlying condition. These conditions may include a lumbar herniated disc , lumbar spinal stenosis , or spinal tumor that affects the cauda equina nerves. Read more about Causes of Cauda Equina Syndrome Spinal tumor Benign or metastatic spine tumors may cause back pain as the first symptom. Over time, they are typically accompanied by other distinguishing symptoms, such as: Unrelenting pain despite rest and medication Fever and chills Night pain Night sweats Progressive or sudden motor weakness in the leg(s) Unexplained weight loss Tumors can originate in the spine or spread to the spine from other parts of the body, in which case they are more likely to lodge in the vertebrae because of the spine’s extensive network of blood vessels. The back and leg symptoms are typically dictated by the location of the tumor in the spine. See Could My Back Pain Be Spine Cancer? Spinal infection Harmful microorganisms can travel to the spine from other parts of the body where infection exists. The resulting spinal infection, called vertebral osteomyelitis , can result in back pain. The symptoms of a spinal infection are variable and depend on the age of the patient, the severity of the infection, and the location in the spine. In addition to back pain, spinal infection symptoms may include some combination of the following: Fever with chills Pain that is worse at night Swelling and possible warmth and redness around the infection site Unexplained weight loss A spinal infection may move into the spinal canal and cause an epidural abscess, which can place pressure on the neural elements, such as the spinal cord, cauda equina, and/or spinal nerve roots. Depending on the level of infection and/or the degree of severity, sciatica-like symptoms, such as numbness, weakness, or paralysis, may occur in the areas of the body below the affected site. See Osteomyelitis Treatments Acute trauma Back pain that occurs immediately after acute trauma to the upper or lower back prompts urgent evaluation. Examples of acute trauma include sudden injuries from events like a slip, fall, playing active sports, or motor vehicle accident. Moderate to severe back pain may develop as the only symptom or may occur in tandem with neurological symptoms, such as: Leg pain and numbness Inability to lift the foot (foot drop) Complete loss of sensation in one or both legs indicating paralysis Injuries from acute trauma to the back can result in a spinal fracture or severe spondylolisthesis , which can compress or injure the spinal cord and/or cauda equina at the level involved. If an underlying bone-weakening condition, such as osteoporosis, exists, even mild trauma may cause compression fractures in the spine. Who May Be Prone to Back Pain from Medical Emergencies While a serious medical condition can affect anyone, some individuals are more prone to these problems due to their underlying health conditions, physical characteristics, and lifestyle habits. This list outlines the groups of people most prone to back pain from medical emergencies: The young and the elderly. The age of the individual is an important initial consideration when diagnosing back pain. Those less than 18 years or more than 50 years of age are typically at a higher likelihood of serious conditions as the cause for the back pain and typically need immediate care when symptoms occur. Tumors and infection occur with higher frequency in both these age groups. 1 Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: 10.1016/j.emc.2010.06.001 Younger individuals are at increased risk of spondylolysis and spondylolisthesis.1 If these conditions are severe, they can affect the neural elements of the spine, causing pain and disability. Elderly individuals are more susceptible to abdominal aortic aneurysm. 3 Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. Older individuals may sustain fractures, including pathologic fractures, even with minor trauma. 1 Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: 10.1016/j.emc.2010.06.001 The immunocompromised. Reduced immunity or a weakened immune system can make individuals susceptible to specific spinal conditions. Examples of the various causes of reduced immunity and the resultant back pain conditions that are likely to occur are outlined below 1 Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: 10.1016/j.emc.2010.06.001 : A history of intravenous drug abuse, and/or recent bacterial infection, such as pneumonia or urinary tract infection, may pose an increased risk for spinal infection. Chronic steroid use and/or a history of cancer are linked to an increased risk for a spinal fracture, even from minor trauma. Cancer in another part of the body, especially in the breast, lung, or prostate, can metastasize in the spine, which is the third most common site for metastatic tumors. As a general rule, any concerning symptom or sign needs to be evaluated by a medical professional. A trained medical professional can adequately evaluate the vital signs, prescribe the necessary diagnostic tests, identify potential neurologic defects, and uncover any red flags. Physicians can also provide timely treatment to prevent the progression of the condition, avoiding permanent damage to the tissues. 1 Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: 10.1016/j.emc.2010.06.001 2 Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: 10.2214/AJR.19.21674 3 Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. 4 Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. 5 Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988 6 Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi: 10.1016/b978-141603618-0.10020-7 Next Page: Back Pain Red-Flags for Emergency Room vs. Physician Consults Pages: 1 2 Dr. Ari Ben-Yishay is a retired orthopedic surgeon who had more than 25 years of experience specializing in surgical and non-surgical spine care. Editor’s Top Picks When Sciatica Pain Is a Medical Emergency Cauda Equina Syndrome Video 2 Sciatica Symptoms That Require Immediate Medical Attention Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency Causes of Cauda Equina Syndrome Metastatic Spinal Cancer Video
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[Home](https://www.spine-health.com/) 2. [Conditions](https://www.spine-health.com/conditions) 3. [Lower Back Pain](https://www.spine-health.com/conditions/lower-back-pain) 4. [When Back Pain May Be a Medical Emergency](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency) # When Back Pain May Be a Medical Emergency By: [Ari Ben-Yishay, MD, Orthopedic Surgeon](https://www.spine-health.com/author/ari-ben-yishay-md) [Peer-Reviewed](https://www.veritashealth.com/editorial-process) The underlying causes for most occurrences of back pain are non-emergent, but the intense pain and related symptoms often elevate anxiety and prompt a visit to the emergency room (ER). While back pain is typically treated in a primary care setting or by a musculoskeletal specialist, physicians are often cautious and look for warning signs of neurologically impairing or life-threatening causes. These causes are rare, but if present, they are considered a medical emergency and warrant immediate treatment to preserve back and/or leg function. Back pain is considered the most common musculoskeletal cause for emergency room visits and typically involves individuals aged 18 to 65 years.[1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub),[2](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote2)Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: [10\.2214/AJR.19.21674](https://doi.org/10.2214/ajr.19.21674) This article provides a comprehensive guide to when back pain may indicate a medical emergency and the associated red-flag symptoms to watch out for. In This Article: - When Back Pain May Be a Medical Emergency - [Back Pain Red-Flags for Emergency Room vs. Physician Consults](https://www.spine-health.com/conditions/lower-back-pain/back-pain-red-flags-emergency-room-vs-physician-consults) ## When an Emergency Room Visit Is Warranted for Back Pain When dealing with severe back pain, making a judgment call about whether to seek help in a doctor’s office or visit the ER may be difficult. The following list describes the symptoms and signs related to conditions that may have resulted in spinal cord, cauda equina, or internal organ damage, which are typically considered as a medical emergency. ### Abdominal aortic aneurysm ![An illustration showing blood supply in the pelvic region.](https://res.cloudinary.com/da1molee1/image/upload/c_fill,g_center,h_439,w_780/q_auto:eco/sciatic-nerve-blood-supply-noheader.png?_a=BAAAV6E0) Save Rupture of the abdominal aorta is a serious medical condition. Lower back pain that radiates to the front abdomen may occur together in a rare, serious medical condition called [abdominal aortic aneurysm](https://www.spine-health.com/conditions/lower-back-pain/abdominal-aortic-aneurysm "Abdominal Aortic Aneurysm"). Classic symptoms include: - A continuous, stabbing pain of severe intensity felt deep in the abdomen between the sternum in the center of the chest and the belly button. - Lower back pain, which may also spread to the groin, pelvis, and/or legs. - A pulsating mass in the abdomen, which may be felt through the skin and is sensitive to touch. - Sudden and rapid heartbeat, shallow breathing, clammy skin and cold sweats, general weakness, confusion, anxiety, and/or loss of consciousness, indicating shock. Abdominal aneurysms are more prevalent among men aged 65 to 75 years who smoke cigarettes.[3](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. See [Abdominal Aortic Aneurysm Causes](https://www.spine-health.com/conditions/lower-back-pain/abdominal-aortic-aneurysm-causes "Abdominal Aortic Aneurysm Causes ") ### Cauda equina syndrome [Skip to video transcript](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#transcript-jwplayer-container-TQcVeEUW) Cauda Equina Syndrome Video 0 seconds of 1 minute, 59 secondsVolume 90% Press shift question mark to access a list of keyboard shortcuts Keyboard Shortcuts EnabledDisabled Shortcuts Open/Close/ or ? Play/PauseSPACE Increase Volume↑ Decrease Volume↓ Seek Forward→ Seek Backward← Captions On/Offc Fullscreen/Exit Fullscreenf Mute/Unmutem Decrease Caption Size\- Increase Caption Size\+ or = Seek %0-9 Next Up 6 Overlooked Remedies for Lower Back Pain Relief Video 04:41 Subtitle Settings Off English Font Color White Font Opacity 100% Font Size 100% Font Family sans-serif Character Edge None Edge Color Black Background Color Black Background Opacity 75% Window Color Black Window Opacity 0% Reset White Black Red Green Blue Yellow Magenta Cyan 100% 75% 50% 25% 200% 175% 150% 125% 100% 75% 50% Arial Courier Georgia Impact Lucida Console Tahoma Times New Roman Trebuchet MS Verdana None Raised Depressed Uniform Drop Shadow White Black Red Green Blue Yellow Magenta Cyan White Black Red Green Blue Yellow Magenta Cyan 100% 75% 50% 25% 0% White Black Red Green Blue Yellow Magenta Cyan 100% 75% 50% 25% 0% facebook x Email pinterest Link https://www.spine-health.com/video/cauda-equina-syndrome-video Copied Auto270p 720p 406p 270p 180p Live 00:00 01:59 01:59 More Videos 04:41 6 Overlooked Remedies for Lower Back Pain Relief Video 01:10 Lumbar Herniated Disc Video 05:02 Lower Back Pain Treatment Video 03:06 Lower Back Pain Causes and Symptoms Video 01:28 Lower Back Strain Video 00:50 Lumbar Spinal Stenosis Video 01:17 Coccydynia (Tailbone Pain) Video 03:42 Lower Back Muscle Strain or Sprain Video Close Save Watch [Cauda Equina Syndrome Video](https://www.spine-health.com/video/cauda-equina-syndrome-video) Show Transcript Damage to the cauda equina nerves can cause [cauda equina syndrome](https://www.spine-health.com/conditions/lower-back-pain/cauda-equina-syndrome "Cauda Equina Syndrome"), a condition that results in severe impairments in the lower back and leg(s). The hallmark symptoms of this condition include: - Difficulty or inability to control bowel movements with sensory loss and decreased sphincter tone in the anal region[4](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote4)Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.,[5](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399/bjgp14X676988](https://bjgp.org/content/64/619/67) - Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, and/or a poor stream[4](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote4)Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.,[5](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399/bjgp14X676988](https://bjgp.org/content/64/619/67) - Numbness in the groin, buttocks, genitals, and/or inner thighs (saddle numbness)[3](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. - Sexual dysfunction[5](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399/bjgp14X676988](https://bjgp.org/content/64/619/67),[6](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote6)Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:[10\.1016/b978-141603618-0.10020-7](https://www.sciencedirect.com/science/article/pii/B9781416036180100207?via%3Dihub) Cauda equina syndrome may occur as a result of acute trauma or develop without an inciting event, due to the progression of an underlying condition. These conditions may include a [lumbar herniated disc](https://www.spine-health.com/conditions/herniated-disc/lumbar-herniated-disc "Lumbar Herniated Disc: What You Should Know"), [lumbar spinal stenosis](https://www.spine-health.com/conditions/spinal-stenosis/lumbar-spinal-stenosis "Lumbar Spinal Stenosis"), or [spinal tumor](https://www.spine-health.com/conditions/spinal-tumor/symptoms-a-spinal-tumor "Symptoms of a Spinal Tumor") that affects the cauda equina nerves. Read more about [Causes of Cauda Equina Syndrome](https://www.spine-health.com/conditions/lower-back-pain/causes-cauda-equina-syndrome "Causes of Cauda Equina Syndrome") advertisement ### Spinal tumor ![An illustration showing tumor in the spine.](https://res.cloudinary.com/da1molee1/image/upload/c_fill,g_center,h_439,w_780/q_auto:eco/adult-spine-bone-tumor.png?_a=BAAAV6E0) Save Spinal tumors may cause neurologic complications. Benign or metastatic spine tumors may cause back pain as the first symptom. Over time, they are typically accompanied by other distinguishing symptoms, such as: - Unrelenting pain despite rest and medication - Fever and chills - Night pain - Night sweats - Progressive or sudden motor weakness in the leg(s) - Unexplained weight loss Tumors can originate in the spine or spread to the spine from other parts of the body, in which case they are more likely to lodge in the vertebrae because of the spine’s extensive network of blood vessels. The back and leg symptoms are typically dictated by the location of the tumor in the spine. See [Could My Back Pain Be Spine Cancer?](https://www.spine-health.com/conditions/spinal-tumor/could-my-back-pain-be-spine-cancer "Could My Back Pain Be Spine Cancer?") ### Spinal infection ![An illustration showing an adult lower body with one leg highlighted in pink.](https://res.cloudinary.com/da1molee1/image/upload/c_fill,g_center,h_439,w_780/q_auto:eco/sciatica-radiating-pain.png?_a=BAAAV6E0) Save Spinal infection may cause sciatica-like symptoms. Harmful microorganisms can travel to the spine from other parts of the body where infection exists. The resulting [spinal infection, called vertebral osteomyelitis](https://www.spine-health.com/conditions/lower-back-pain/osteomyelitis-a-spinal-infection), can result in back pain. The symptoms of a spinal infection are variable and depend on the age of the patient, the severity of the infection, and the location in the spine. In addition to back pain, spinal infection symptoms may include some combination of the following: - Fever with chills - Pain that is worse at night - Swelling and possible warmth and redness around the infection site - Unexplained weight loss A spinal infection may move into the spinal canal and cause an epidural abscess, which can place pressure on the neural elements, such as the spinal cord, cauda equina, and/or spinal nerve roots. Depending on the level of infection and/or the degree of severity, sciatica-like symptoms, such as numbness, weakness, or paralysis, may occur in the areas of the body below the affected site. See [Osteomyelitis Treatments](https://www.spine-health.com/conditions/lower-back-pain/osteomyelitis-treatments "Osteomyelitis Treatments") ### Acute trauma ![An illustration of an adult foot showing foot drop.](https://res.cloudinary.com/da1molee1/image/upload/c_fill,g_center,h_439,w_780/q_auto:eco/foot-drop.png?_a=BAAAV6E0) Save Back trauma may result in foot weakness, numbness, and functional loss. Back pain that occurs immediately after acute trauma to the upper or lower back prompts urgent evaluation. Examples of acute trauma include sudden injuries from events like a slip, fall, playing active sports, or motor vehicle accident. Moderate to severe back pain may develop as the only symptom or may occur in tandem with neurological symptoms, such as: - Leg pain and numbness - Inability to lift the foot (foot drop) - Complete loss of sensation in one or both legs indicating paralysis Injuries from acute trauma to the back can result in a [spinal fracture](https://www.spine-health.com/conditions/osteoporosis/when-back-pain-a-spine-compression-fracture "When Back Pain Is a Spine Compression Fracture") or severe [spondylolisthesis](https://www.spine-health.com/conditions/spondylolisthesis/spondylolysis-and-spondylolisthesis "Spondylolysis and Spondylolisthesis"), which can compress or injure the spinal cord and/or cauda equina at the level involved. If an underlying bone-weakening condition, such as osteoporosis, exists, even mild trauma may cause compression fractures in the spine. advertisement ## Who May Be Prone to Back Pain from Medical Emergencies ![An illustration showing people of different age group.](https://res.cloudinary.com/da1molee1/image/upload/c_fill,g_center,h_439,w_780/q_auto:eco/family-snow-vacation-illustrated.png?_a=BAAAV6E0) Save Individuals below 18 years and over 50 years of age are typically at a higher likelihood of serious back conditions. While a serious medical condition can affect anyone, some individuals are more prone to these problems due to their underlying health conditions, physical characteristics, and lifestyle habits. This list outlines the groups of people most prone to back pain from medical emergencies: - The young and the elderly. The age of the individual is an important initial consideration when diagnosing back pain. Those less than 18 years or more than 50 years of age are typically at a higher likelihood of serious conditions as the cause for the back pain and typically need immediate care when symptoms occur. - Tumors and infection occur with higher frequency in both these age groups.[1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub) - Younger individuals are at increased risk of spondylolysis and spondylolisthesis.1 If these conditions are severe, they can affect the neural elements of the spine, causing pain and disability. - Elderly individuals are more susceptible to abdominal aortic aneurysm.[3](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. - Older individuals may sustain fractures, including pathologic fractures, even with minor trauma.[1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub) - The immunocompromised. Reduced immunity or a weakened immune system can make individuals susceptible to specific spinal conditions. Examples of the various causes of reduced immunity and the resultant back pain conditions that are likely to occur are outlined below[1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub): - A history of intravenous drug abuse, and/or recent bacterial infection, such as pneumonia or urinary tract infection, may pose an increased risk for spinal infection. - Chronic steroid use and/or a history of cancer are linked to an increased risk for a spinal fracture, even from minor trauma. - Cancer in another part of the body, especially in the breast, lung, or prostate, can metastasize in the spine, which is the third most common site for metastatic tumors. As a general rule, any concerning symptom or sign needs to be evaluated by a medical professional. A trained medical professional can adequately evaluate the vital signs, prescribe the necessary diagnostic tests, identify potential neurologic defects, and uncover any red flags. Physicians can also provide timely treatment to prevent the progression of the condition, avoiding permanent damage to the tissues. References - [1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref1_FjeB-P2E7GsjWKtDHJEn0j6-JIzLGfx-eJYkGRUdAA_le7KleJpNIaA) Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub) - [2](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref2_r36l61-gkin1T7VGDkDqVk7a80yCeWAwXOri4oDUkw_dym7Kzricu65) Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: [10\.2214/AJR.19.21674](https://doi.org/10.2214/ajr.19.21674) - [3](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref3_cvrQBIo2jYdrd9RGMRn448gzkB1W18ut0nG6L0ozl4_rfaZ68T1WI38) Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. - [4](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref4_QPxsUPG4l7Uput2GXvLdk53Ewo3o68Kg7yTf7MN-dg_p15CMYj7qawB) Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. - [5](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref5_YKiAn9cyTscUTvo-mIxFbOkCtt2zKwh5qPWIi0b278_zg60JZffslbt) Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399/bjgp14X676988](https://bjgp.org/content/64/619/67) - [6](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref6_ew4155PxQC-J8yZPCAjK1RAO07eyWCRD-lxH2ThwM0_mbPODZiufAG6) Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:[10\.1016/b978-141603618-0.10020-7](https://www.sciencedirect.com/science/article/pii/B9781416036180100207?via%3Dihub) [Get our FREE Guide to Natural Back Pain Relief](https://www.spine-health.com/newsletter?offer=GUIDE-NaturalBackPainRelief) ## Pagination Next Page: [Back Pain Red-Flags for Emergency Room vs. Physician Consults](https://www.spine-health.com/conditions/lower-back-pain/back-pain-red-flags-emergency-room-vs-physician-consults) Pages: - 1 - [2](https://www.spine-health.com/conditions/lower-back-pain/back-pain-red-flags-emergency-room-vs-physician-consults) [![Ari Ben-Yishay](https://res.cloudinary.com/da1molee1/image/upload/c_fill,g_north,h_120,w_120/q_auto:eco/ari-ben-yishay.jpeg?_a=BAAAV6E0)](https://www.spine-health.com/author/ari-ben-yishay-md) Dr. Ari Ben-Yishay is a retired orthopedic surgeon who had more than 25 years of experience specializing in surgical and non-surgical spine care. - [Share on Facebook](https://www.facebook.com/sharer.php?u=&t=) - [Share on Pinterest](http://pinterest.com/pin/create/link/?url=&description=) - [Subscribe to our newsletter](https://www.spine-health.com/newsletter) - Print this article - [Email this article](mailto:?body=%26subject=&body=&subject=) advertisement ## Editor’s Top Picks - [When Sciatica Pain Is a Medical Emergency](https://www.spine-health.com/conditions/sciatica/when-sciatica-pain-medical-emergency) - [Cauda Equina Syndrome Video](https://www.spine-health.com/video/cauda-equina-syndrome-video) - [2 Sciatica Symptoms That Require Immediate Medical Attention](https://www.spine-health.com/blog/2-sciatica-symptoms-require-immediate-medical-attention) - [Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency](https://www.spine-health.com/conditions/sciatica/piriformis-syndrome-when-symptoms-indicate-medical-emergency) - [Causes of Cauda Equina Syndrome](https://www.spine-health.com/conditions/lower-back-pain/causes-cauda-equina-syndrome) - [Metastatic Spinal Cancer Video](https://www.spine-health.com/video/metastatic-spinal-cancer-video) advertisement advertisement ## Popular Videos [![](https://res.cloudinary.com/da1molee1/image/upload/w_150,h_84,q_80/lowerbackpaintreatment-35.webp?_a=BAAAV6E0) 5:02 Lower Back Pain Treatment Video](https://www.spine-health.com/video/lower-back-pain-treatment-video) [![](https://res.cloudinary.com/da1molee1/image/upload/w_150,h_84,q_80/inflammatory-protein-nerve-contact.webp?_a=BAAAV6E0) 1:45 Herniated Disc Symptoms Animation](https://www.spine-health.com/video/herniated-disc-symptoms-animation) [![](https://res.cloudinary.com/da1molee1/image/upload/w_150,h_84,q_80/cervical-degenerative-disc-disease.webp?_a=BAAAV6E0) 1:31 Cervical Degenerative Disc Disease Video](https://www.spine-health.com/video/cervical-degenerative-disc-disease-video) [![](https://res.cloudinary.com/da1molee1/image/upload/w_150,h_84,q_80/vid-326.webp?_a=BAAAV6E0) 5:51 McKenzie Method Exercises for Back Pain and Sciatica Video](https://www.spine-health.com/video/mckenzie-method-exercises-back-pain-and-sciatica-video) Pain Evaluation Tool Sponsored by: [Boston Scientific](http://pubads.g.doubleclick.net/gampad/clk?id=6745229490&iu=/1006215) Your Pain is Unique No one knows your pain better than you. 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Readable Markdown	The underlying causes for most occurrences of back pain are non-emergent, but the intense pain and related symptoms often elevate anxiety and prompt a visit to the emergency room (ER). While back pain is typically treated in a primary care setting or by a musculoskeletal specialist, physicians are often cautious and look for warning signs of neurologically impairing or life-threatening causes. These causes are rare, but if present, they are considered a medical emergency and warrant immediate treatment to preserve back and/or leg function. Back pain is considered the most common musculoskeletal cause for emergency room visits and typically involves individuals aged 18 to 65 years.[1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub),[2](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote2)Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: [10\.2214/AJR.19.21674](https://doi.org/10.2214/ajr.19.21674) This article provides a comprehensive guide to when back pain may indicate a medical emergency and the associated red-flag symptoms to watch out for. In This Article: ## When an Emergency Room Visit Is Warranted for Back Pain When dealing with severe back pain, making a judgment call about whether to seek help in a doctor’s office or visit the ER may be difficult. The following list describes the symptoms and signs related to conditions that may have resulted in spinal cord, cauda equina, or internal organ damage, which are typically considered as a medical emergency. ### Abdominal aortic aneurysm Lower back pain that radiates to the front abdomen may occur together in a rare, serious medical condition called [abdominal aortic aneurysm](https://www.spine-health.com/conditions/lower-back-pain/abdominal-aortic-aneurysm "Abdominal Aortic Aneurysm"). Classic symptoms include: - A continuous, stabbing pain of severe intensity felt deep in the abdomen between the sternum in the center of the chest and the belly button. - Lower back pain, which may also spread to the groin, pelvis, and/or legs. - A pulsating mass in the abdomen, which may be felt through the skin and is sensitive to touch. - Sudden and rapid heartbeat, shallow breathing, clammy skin and cold sweats, general weakness, confusion, anxiety, and/or loss of consciousness, indicating shock. Abdominal aneurysms are more prevalent among men aged 65 to 75 years who smoke cigarettes.[3](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. See [Abdominal Aortic Aneurysm Causes](https://www.spine-health.com/conditions/lower-back-pain/abdominal-aortic-aneurysm-causes "Abdominal Aortic Aneurysm Causes ") ### Cauda equina syndrome Damage to the cauda equina nerves can cause [cauda equina syndrome](https://www.spine-health.com/conditions/lower-back-pain/cauda-equina-syndrome "Cauda Equina Syndrome"), a condition that results in severe impairments in the lower back and leg(s). The hallmark symptoms of this condition include: - Difficulty or inability to control bowel movements with sensory loss and decreased sphincter tone in the anal region[4](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote4)Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.,[5](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399/bjgp14X676988](https://bjgp.org/content/64/619/67) - Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, and/or a poor stream[4](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote4)Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28.,[5](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399/bjgp14X676988](https://bjgp.org/content/64/619/67) - Numbness in the groin, buttocks, genitals, and/or inner thighs (saddle numbness)[3](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. - Sexual dysfunction[5](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote5)Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399/bjgp14X676988](https://bjgp.org/content/64/619/67),[6](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote6)Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:[10\.1016/b978-141603618-0.10020-7](https://www.sciencedirect.com/science/article/pii/B9781416036180100207?via%3Dihub) Cauda equina syndrome may occur as a result of acute trauma or develop without an inciting event, due to the progression of an underlying condition. These conditions may include a [lumbar herniated disc](https://www.spine-health.com/conditions/herniated-disc/lumbar-herniated-disc "Lumbar Herniated Disc: What You Should Know"), [lumbar spinal stenosis](https://www.spine-health.com/conditions/spinal-stenosis/lumbar-spinal-stenosis "Lumbar Spinal Stenosis"), or [spinal tumor](https://www.spine-health.com/conditions/spinal-tumor/symptoms-a-spinal-tumor "Symptoms of a Spinal Tumor") that affects the cauda equina nerves. Read more about [Causes of Cauda Equina Syndrome](https://www.spine-health.com/conditions/lower-back-pain/causes-cauda-equina-syndrome "Causes of Cauda Equina Syndrome") Spinal tumor Benign or metastatic spine tumors may cause back pain as the first symptom. Over time, they are typically accompanied by other distinguishing symptoms, such as: - Unrelenting pain despite rest and medication - Fever and chills - Night pain - Night sweats - Progressive or sudden motor weakness in the leg(s) - Unexplained weight loss Tumors can originate in the spine or spread to the spine from other parts of the body, in which case they are more likely to lodge in the vertebrae because of the spine’s extensive network of blood vessels. The back and leg symptoms are typically dictated by the location of the tumor in the spine. See [Could My Back Pain Be Spine Cancer?](https://www.spine-health.com/conditions/spinal-tumor/could-my-back-pain-be-spine-cancer "Could My Back Pain Be Spine Cancer?") ### Spinal infection Harmful microorganisms can travel to the spine from other parts of the body where infection exists. The resulting [spinal infection, called vertebral osteomyelitis](https://www.spine-health.com/conditions/lower-back-pain/osteomyelitis-a-spinal-infection), can result in back pain. The symptoms of a spinal infection are variable and depend on the age of the patient, the severity of the infection, and the location in the spine. In addition to back pain, spinal infection symptoms may include some combination of the following: - Fever with chills - Pain that is worse at night - Swelling and possible warmth and redness around the infection site - Unexplained weight loss A spinal infection may move into the spinal canal and cause an epidural abscess, which can place pressure on the neural elements, such as the spinal cord, cauda equina, and/or spinal nerve roots. Depending on the level of infection and/or the degree of severity, sciatica-like symptoms, such as numbness, weakness, or paralysis, may occur in the areas of the body below the affected site. See [Osteomyelitis Treatments](https://www.spine-health.com/conditions/lower-back-pain/osteomyelitis-treatments "Osteomyelitis Treatments") ### Acute trauma Back pain that occurs immediately after acute trauma to the upper or lower back prompts urgent evaluation. Examples of acute trauma include sudden injuries from events like a slip, fall, playing active sports, or motor vehicle accident. Moderate to severe back pain may develop as the only symptom or may occur in tandem with neurological symptoms, such as: - Leg pain and numbness - Inability to lift the foot (foot drop) - Complete loss of sensation in one or both legs indicating paralysis Injuries from acute trauma to the back can result in a [spinal fracture](https://www.spine-health.com/conditions/osteoporosis/when-back-pain-a-spine-compression-fracture "When Back Pain Is a Spine Compression Fracture") or severe [spondylolisthesis](https://www.spine-health.com/conditions/spondylolisthesis/spondylolysis-and-spondylolisthesis "Spondylolysis and Spondylolisthesis"), which can compress or injure the spinal cord and/or cauda equina at the level involved. If an underlying bone-weakening condition, such as osteoporosis, exists, even mild trauma may cause compression fractures in the spine. Who May Be Prone to Back Pain from Medical Emergencies While a serious medical condition can affect anyone, some individuals are more prone to these problems due to their underlying health conditions, physical characteristics, and lifestyle habits. This list outlines the groups of people most prone to back pain from medical emergencies: - The young and the elderly. The age of the individual is an important initial consideration when diagnosing back pain. Those less than 18 years or more than 50 years of age are typically at a higher likelihood of serious conditions as the cause for the back pain and typically need immediate care when symptoms occur. - Tumors and infection occur with higher frequency in both these age groups.[1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub) - Younger individuals are at increased risk of spondylolysis and spondylolisthesis.1 If these conditions are severe, they can affect the neural elements of the spine, causing pain and disability. - Elderly individuals are more susceptible to abdominal aortic aneurysm.[3](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote3)Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. - Older individuals may sustain fractures, including pathologic fractures, even with minor trauma.[1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub) - The immunocompromised. Reduced immunity or a weakened immune system can make individuals susceptible to specific spinal conditions. Examples of the various causes of reduced immunity and the resultant back pain conditions that are likely to occur are outlined below[1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnote1)Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub): - A history of intravenous drug abuse, and/or recent bacterial infection, such as pneumonia or urinary tract infection, may pose an increased risk for spinal infection. - Chronic steroid use and/or a history of cancer are linked to an increased risk for a spinal fracture, even from minor trauma. - Cancer in another part of the body, especially in the breast, lung, or prostate, can metastasize in the spine, which is the third most common site for metastatic tumors. As a general rule, any concerning symptom or sign needs to be evaluated by a medical professional. A trained medical professional can adequately evaluate the vital signs, prescribe the necessary diagnostic tests, identify potential neurologic defects, and uncover any red flags. Physicians can also provide timely treatment to prevent the progression of the condition, avoiding permanent damage to the tissues. - [1](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref1_FjeB-P2E7GsjWKtDHJEn0j6-JIzLGfx-eJYkGRUdAA_le7KleJpNIaA) Corwell BN. The emergency department evaluation, management, and treatment of back pain. Emergency Medicine Clinics of North America. 2010;28(4):811-839. doi: [10\.1016/j.emc.2010.06.001](https://www.sciencedirect.com/science/article/abs/pii/S0733862710000465?via%3Dihub) - [2](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref2_r36l61-gkin1T7VGDkDqVk7a80yCeWAwXOri4oDUkw_dym7Kzricu65) Pakpoor J, Raad M, Harris A, et al. Use of imaging during emergency department visits for low back pain. American Journal of Roentgenology. 2020;214(2):395-399. doi: [10\.2214/AJR.19.21674](https://doi.org/10.2214/ajr.19.21674) - [3](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref3_cvrQBIo2jYdrd9RGMRn448gzkB1W18ut0nG6L0ozl4_rfaZ68T1WI38) Fact Sheet: Abdominal Aortic Aneurysm. Center for Disease Control and Prevention Website. Updated Sept 08, 2020. Accessed January 15, 2021. - [4](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref4_QPxsUPG4l7Uput2GXvLdk53Ewo3o68Kg7yTf7MN-dg_p15CMYj7qawB) Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. - [5](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref5_YKiAn9cyTscUTvo-mIxFbOkCtt2zKwh5qPWIi0b278_zg60JZffslbt) Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. [doi:10.3399/bjgp14X676988](https://bjgp.org/content/64/619/67) - [6](https://www.spine-health.com/conditions/lower-back-pain/when-back-pain-may-be-medical-emergency#footnoteref6_ew4155PxQC-J8yZPCAjK1RAO07eyWCRD-lxH2ThwM0_mbPODZiufAG6) Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:[10\.1016/b978-141603618-0.10020-7](https://www.sciencedirect.com/science/article/pii/B9781416036180100207?via%3Dihub) Next Page: [Back Pain Red-Flags for Emergency Room vs. Physician Consults](https://www.spine-health.com/conditions/lower-back-pain/back-pain-red-flags-emergency-room-vs-physician-consults) Pages: - 1 - [2](https://www.spine-health.com/conditions/lower-back-pain/back-pain-red-flags-emergency-room-vs-physician-consults) [![Ari Ben-Yishay](https://res.cloudinary.com/da1molee1/image/upload/c_fill,g_north,h_120,w_120/q_auto:eco/ari-ben-yishay.jpeg?_a=BAAAV6E0)](https://www.spine-health.com/author/ari-ben-yishay-md) Dr. Ari Ben-Yishay is a retired orthopedic surgeon who had more than 25 years of experience specializing in surgical and non-surgical spine care. ## Editor’s Top Picks - [When Sciatica Pain Is a Medical Emergency](https://www.spine-health.com/conditions/sciatica/when-sciatica-pain-medical-emergency) - [Cauda Equina Syndrome Video](https://www.spine-health.com/video/cauda-equina-syndrome-video) - [2 Sciatica Symptoms That Require Immediate Medical Attention](https://www.spine-health.com/blog/2-sciatica-symptoms-require-immediate-medical-attention) - [Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency](https://www.spine-health.com/conditions/sciatica/piriformis-syndrome-when-symptoms-indicate-medical-emergency) - [Causes of Cauda Equina Syndrome](https://www.spine-health.com/conditions/lower-back-pain/causes-cauda-equina-syndrome) - [Metastatic Spinal Cancer Video](https://www.spine-health.com/video/metastatic-spinal-cancer-video)
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