It’s one thing to have back or neck pain; it’s another if the spinal cord is affected. Spinal cord disease can result in paralysis (picture a broken neck). Fortunately, even though back & neck pains are common, diseases of the spinal cord are very rare. Although a number of spinal cord conditions cause back or neck pain, the main symptoms come from damaged nerves.
Weakness is the most important finding, since we can easily test patient’s strength against resistance. A skilled clinician can distinguish between weakness caused simply by pain, and true neurologic weakness due to one or more nerves. Weakness can come from less serious conditions, like a slipped disk, but then it’s only on one side of the body. True neurologic weakness in both arms and/or legs in somebody with neck or back pain makes us really worry.
Other symptoms that suggest something is wrong with the spinal cord include:
- New numbness or tingling around the anus and/or genitals
- New abrupt major urine or bowel problems like can’t hold it in at all (incontinence), or can’t go at all (retention)
- For spinal cord in the neck: electric shock runs down the body upon bending the neck down (“Lhermitte’s Sign”)
- Loss of sensation on both sides of the body from a certain level on down, but this is vaguer. Lots of healthy people have normal numbness or tingling in feet or legs, especially at night. Also, anxiety can cause all sorts of numbness. True loss of sensation means not feeling it when getting poked with a pin.
If we suspect a spinal cord disease, we send the patient right to an ER, sometimes by ambulance. An MRI and other tests can make a diagnosis. Some conditions require emergency surgery.
Some of the diseases that affect the spinal cord are listed below. For these, back or neck pain is usually a prominent symptom.
- Epidural abscess: infection in the area between the spinal cord and the spine (see Diagram — Anatomy of the Spine). Suspect if back pain with fever, and one spot very tender to tapping on it
- Epidural metastasis: cancer spreading to epidural space (see above). Suspect in patient with cancer, new back pain, one spot very tender to tapping on it
- Bone infections: Suspect if back pain with fever, and one spot very tender to tapping on it
- Spinal cord compression (in the neck)
- Spinal Tumors
- Transverse Myelitis: Rare condition triggered by the immune system. May occur in patients with other autoimmune diseases (Lupus, Sjogren’s etc.)
- Viral infections
- Epidural Bleeding, usually only in someone taking anticoagulants (“blood thinners”)