WHEN TO SEE A SPINE SPECIALIST

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 prompt medial advice if you develop rapid onset extremity pain, numbness, tingling or weakness. 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

SCREENING AND DIAGNOSIS

Physicians diagnose transverse myelitis by taking a medical history and performing a thorough neurological examination. Because it is often difficult to distinguish between a patient with an idiopathic form of transverse myelitis and one who has an underlying condition, physicians must first eliminate potentially treatable causes of the condition. If a spinal cord injury is suspected, physicians seek first to rule out lesions (damaged or abnormally functioning areas) that could cause spinal cord compression. Such potential lesions include tumors, herniated or slipped discs, stenosis (narrowing of the canal that holds the spinal cord), and abscesses. To rule out such lesions and check for inflammation of the spinal cord, patients often undergo magnetic resonance imaging (MRI), a procedure that provides a picture of the brain and spinal cord. Physicians also may perform myelography, which involves injecting a dye into the sac that surrounds the spinal cord. The patient is then tilted up and down to let the dye flow around and outline the spinal cord while X-rays are taken.

Blood tests may be performed to rule out various disorders such as systemic lupus erythematosus, HIV infection, and vitamin B12 deficiency. In some patients with transverse myelitis, the cerebrospinal fluid that bathes the spinal cord and brain contains more protein than usual and an increased number of leukocytes (white blood cells), indicating possible infection. A spinal tap may be performed to obtain fluid to study these factors. If none of these tests suggests a specific cause, the patient is presumed to have idiopathic transverse myelitis.