WHEN TO SEE A SPINE SPECIALIST

If you experience neck or back pain that interferes with your normal activities for longer than a few days, call your doctor to be evaluated. If neck or back pain increases when you cough or sneeze you may have a herniated disc. If you experience neck or back pain that persists or progresses you should be seen by a physician. If you lose control of your bladder or bowels, or if you develop numbness or weakness in the arms or legs, seek prompt medical attention. If you develop numbness and weakness in both legs you may have a condition referred to as a cauda equina syndrome. This can develop secondary to compression of several spinal nerves in the low back (lumbar spine). Causes include a cyst, tumor, disc herniation or abcess.. This condition may require prompt surgery

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

Thoracic disc herniations occur much less often than cervical herniations.

SIGNS AND SYMPTOMS

You can have a herniated disc without any symptoms at all. Asymptomatic herniated discs are often detected as incidental findings on advanced forms of diagnostic imaging such as MRI or CT scans. The degree of symptoms does not always correlate with the size and location of the disc herniation.  The most common signs and symptoms of a herniated disc are:

• Radiating extremity pain. This may occur with numbness and tingling. When these symptoms occur in the legs secondary to lumbar disc herniation it is often referred to as sciatica. Sciatica is characterized by radiating leg pain that often feels like it starts in the buttock.
•  Focal neck or back pain.
• Extremity numbness and/or tingling. This may be associated with a loss of sensation of the involved extremity.
•  Extremity muscle weakness. If a disc herniation compromises a spinal nerve (radiculopathy) it can result in a loss of nerve signals to certain muscles resulting in muscle weakness and muscle shrinkage (atrophy). 
• Back pain which gets worse when sitting, coughing or sneezing.

If there is compression of the spinal cord in the neck or midback secondary to a disc herniation this can cause muscle weakness and muscle tightness (spasticity) below the level of compromise. In severe cases it can lead to bowel and/or bladder dysfunction as well as gait abnormalities. Compression of multiple spinal nerves in the low back (lumbar) region can casue a cauda equina syndrome characterized by nerve symptoms and a loss of normal bladder function. Spina cord compression with signs and symptoms and cauda equina syndrome both represent a potential surgical emergency.