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 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

Mechanical (orthopedic) tests are performed to purposely stress a spinal nerve to see how irritable it is. This can be done by applying positions that stretch and/or compress the nerve.  Nerve root irritability signs can often be elicited prior to the development of obvious sensory loss, reflex changes, or muscular weakness.

Muscle stretch reflexes also referred to as deep tendon reflexes are used to evaluate the integrity of the spinal nerves. The muscle stretch reflex is an involuntary response produced by tapping on a tendon attached to a muscle.  Since the reflex response is normally present in many muscles, its absence is significant and signifies a neurological problem.

Muscle weakness can develop secondary to spinal nerve compromise.  All of the muscles that receive their nerve supply from a spinal nerve are collectively referred to as a myotome. Moderate-to-severe radiculopathy is usually associated with some degree of muscle weakness.  In milder cases of nerve root compromise the only muscle symptoms may be exertional-induced fatigue and occasional muscle cramping.  Needle electromyography (EMG) is the gold standard for identifying a loss of nerve supply to muscle (denervation).