- Cauda equina or spinal cord compression is a medical emergency that requires immediate attention. Severe back pain, saddle paresthesia, weakness, bladder retention or bowel incontinence are all symptoms of compression
- On exam, there may be signs of upper or lower motor neuron weakness depending on where the compression is (spinal cord vs the cauda equina nerve roots)
- Dexamethasone can decrease spinal cord edema if compression is confirmed. An urgent surgery consult for possible decompression is needed. There is also a role for radiation depending on the cause of compression, for example in metastatic bone disease
- Based on the American College of Radiology guidelines, other 'red flags' of back pain that require imaging include age > 70 (or > 50 with osteoporotic risk factors), history of cancer or surgery, unexplained fever or weight loss, immunocompromised state, IV drug use, trauma, or if the back pain persists for greater than 6 weeks
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