Spinal fractures may occur following a severe trauma or a more minor force. The key issues to address are ongoing pain, compression of nerves, any deformity that has occurred as a result of the fracture or the risk of further displacement or movement at the fracture site. Key initial investigations to assess the degree of damage include a MRI and / or CT. Further tests may include an assessment may include an evaluation of the patient’s underlying bone mineral density with a DEXA scan.
Tumours are a rare cause of back pain. They may be associated with ongoing severe back pain. This may wake patients at night from sleep. They may also cause neurological symptoms such as pain, altered sensation or weaknees in a particular nerve distribution.
Patients may present with other symptoms related to another tumour such as weight loss, altered bowel habit, or palpable mass. Patients with this presentation warrant urgent work up which will typically include a MRI unless this is not possible due for example to an implanted spinal cord stimulator.
Spinal infections may spread from other areas around the body, travelling in the bloodstream to the spine. The disc spaces are particularly vulnerable due to their limited blood supply. Infection may cause increasing damage to the structures in the spinal column including the discs and bones which can give rise to severe pain. Patients may or may not have obvious signs of sepsis such as raised temperatures, shivering or sweating.