Red Flag (Emergency) Situations

Some symptoms of back pain should be considered an emergency because the nerve damage associated with them may be irreversible if they are not treated immediately. Red flag (emergency) situations are often placed in a separate category from the other back pain problems because they require immediate medical attention. If a patient experiences weakness in their leg to the point where it is difficult to walk, or a loss of bladder/bowel control, they should be immediately see by their spine doctor or should go to the emergency room. Red flag situations include back pain due to trauma (fracture), tumor, infection, and severe compression causing disability affecting bladder/bowel control. Cauda equina syndrome is one disorder involving severe nerve compression that may affect a person's ability to control their bodily functions. In situations where back pain is associated with fracture, tumor, and infection, the person should be immediately seen and treated appropriately. Similar immediate evaluation and treatment should occur if cauda equina syndrome is suspected or symptoms of it are presented. If the cause of cauda equina syndrome is not treated, the person may suffer permanent nerve damage. Although you should be knowledgeable of possible syndromes requiring immediate evaluation/treatment, you should also know that they are rare compared to pinched nerve and sprain and strain syndromes.

Recognizing red flag (emergency) situations is important so that you do not suffer permanent disability or loss of sensation. While many back pain problems will heal on their own , these situations should be treated right away: You should consult your spine doctor or go to the emergency room if you have back pain and:
  • Your bones are tender
  • You are unable to comfortable sit or stand in one position
  • You experience unrelenting pain
  • Your symptoms continue without improvement or get worse
  • Weight loss
  • Fever
  • You also have health conditions/disease such as immunosupression, injection drug use, and Diabetes mellitus
  • Infection
  • Have just been in an accident or suffered recent trauma
  • A known malignancy or tumor
  • Cauda equina syndrome of saddle amnesia (numbness in the genital/anal regions) and/or loss of bladder or bowel control (incontinence)
  • Bacterial infection of the spine


Bacterial infections of the facet joints (infectious arthritis), one or more vertebrae (osteomyelitis), or one or more disks (diskitis) are rare but do strike. Though most bacterial infections are transmitted through the bloodstream, some strains may reach the spine through the cerebro-spinal fluid. The infection may breach the body through breaks in the skin, unsterilized hypodermic needle, abscessed tooth, or urinary tract infection. Your risk of developing an infection of the vertebral bone(s) or soft tissue tissues of the back are greater if you have another medical problem compromising your immune system (such as AIDS, Hepatitis).

Patients who feel a sudden loss of sensation or strength in one or more of their limbs as a result of injury should stay where they are, and not attempt to move or get up from the site of trauma. If anyone is around you at the site of trauma, you should ask them to ask for help or call 911.