Neck and Back Pain

Abstract

Acute back and neck pain is a common complaint seen in the emergency department. Chronic pain, lasting more than several months, can be indicative of an underlying back condition such as disk (nucleus pulposus) herniation, spinal stenosis, or cervical spondylosis in cases of neck pain. A comprehensive back or neck pain assessment is required for appropriate treatment. In the trauma patient, acute neck pain necessitates neck immobilization to prevent untoward cervical cord damage.

The history should indicate whether the patient has symptoms of spinal cord or root compromise including limb weakness, radicular pain and numbness (including saddle anesthesia), bowel, bladder, or erectile dysfunction. Apart from the routinely comprehensive neurological examination, the patient should be evaluated for spinal and paraspinal tenderness, Lhermitte’s sign, Spurling’s maneuver, as well as positive straight leg raising. Signs of myelopathy should also be thoroughly excluded.

Lab tests include a CBC and inflammatory markers (ESR and CRP) to detect infectious/inflammatory etiologies. Multiple imaging modalities may be helpful and include plain x-rays, CT, and MRI spine scans. Sometimes the use of flexion and extension views is quite informative regarding spine stability.

Specific treatments depend on the underlying cause and range from conservative measures with symptomatic medications (analgesics, muscle relaxants) and physical therapy to more interventional options like local/regional anesthetic blocks and spinal steroid injections. Surgical decision-making is complex but is usually based on the presence of significant, active neural compromise.