Do These 4 Back Pain Red Flags Mean You Need Surgery?
Do These 4 Back Pain Red Flags Mean You Need Surgery?
Understanding Back Pain: When Should You Worry?
If you’re one of the 85% of people who will experience back pain in their life, then this video is for you. It is critical you understand the warning signs associated with back pain so you know when to seek urgent medical attention, and I’m here to explain just that.
Most Back Pain Is Temporary
Let’s talk about when back pain is something you need to worry about—and when it’s not. As a board-certified neurosurgeon, I have treated thousands of spine patients, and what I’m about to share could help you make a critical decision about your spine care.
First, let me put your mind at ease with some important statistics: back pain is incredibly common, and the good news is that the majority of people experience improvement in their pain within 1 to 6 weeks. Ninety-five percent of people will have recovered within 3 months.
Now, 40% of people will have another episode of back pain within 6 months of their first one. This is completely normal and doesn’t necessarily mean that anything is seriously wrong. Most causes of back pain are what we call benign, meaning they won’t cause any significant or chronic harm. In fact, many of these cases won’t ever require surgery.
Start With Your Primary Care Provider
This is why it is important for you to start with your primary care provider. They can work toward identifying the cause of your pain and guide you through the next appropriate steps and treatment options. They can identify if and when you should see a spine surgeon.
The 4 Red Flags of Back Pain
But there are certain situations—what we call red flags—when you need to seek immediate medical attention. I’m going to walk you through four major red flags that tell you it’s time to seek immediate care.
1. Back Pain With Neurological Symptoms
The first red flag is that your back pain is associated with neurological symptoms. If you’re experiencing weakness or loss of sensation in your legs, you need to be evaluated immediately.
Symptoms can include numbness in your legs or an inability to move your legs, such as dragging your foot when you walk, being unable to push off the ground, or having difficulty lifting your legs up to go upstairs or get into a vehicle.
If you develop back pain associated with leg weakness, this warrants prompt attention.
2. Bladder or Bowel Dysfunction
The second red flag—and this is absolutely critical—involves problems with bladder or bowel function. If you experience new difficulty with urination, urinary incontinence, or fecal incontinence, you need immediate medical attention.
Let me be very specific here: if you are having bowel movements without realizing it, or if you can’t feel when you need to pee and you have an accident, these are serious warning signs.
These symptoms could indicate something called cauda equina syndrome. Cauda equina is a Latin term for “horse’s tail,” and it represents the bundle of nerves that leave the bottom of your spinal cord and travel through your spine and your low back.
These nerves exit through tunnels and leave your lumbar and sacral spine, then provide sensation and function to your legs, bowel, and bladder. If these nerves get compressed—perhaps from a large herniated disc—it can lead to progressive loss of leg, bowel, and bladder function, and this can be permanent.
This is a true surgical emergency. If these symptoms come on suddenly or they rapidly progress, you need to get to the emergency room immediately.
3. History of Cancer With New Back Pain
The third red flag involves a cancer history. If you have a known cancer that has spread to another area of your body and you have developed new significant back pain, this warrants evaluation by a medical provider.
Your pain could potentially indicate cancer affecting your spine. Additionally, if you’re experiencing unexplained weight loss with new back pain, this combination requires prompt medical attention.
4. Risk of Infection or Spine Fracture
The fourth red flag is infection. There are specific situations where you’re at a higher risk of a spine infection. These include recent severe illness, blood infections, IV drug use, a suppressed immune system, or recent surgery.
If you’ve had any of these risk factors and you develop back pain, you need to be evaluated to rule out an infection of your spine.
There’s an additional situation that requires immediate medical attention, and that is in the setting of a traumatic injury in which you could have endured a spine fracture.
You’re at a higher risk for having a spine fracture if you’re on long-term corticosteroids, have known osteoporosis, or if you’ve experienced a traumatic event such as a fall or a motor vehicle accident.
If you have severe back pain and any of these risk factors, you should seek immediate medical evaluation.
Most Back Pain Will Resolve on Its Own
Let me emphasize something here: these red flags are the exception, not the rule.
Remember those statistics I shared earlier—the vast majority of back pain resolves on its own. But knowing and recognizing these warning signs could save your function—or even your life—in certain situations.
When to Seek Help and When to Wait
So here’s what I want you to take away from this:
Most back pain isn’t dangerous. But you need to know these warning signs. If you experience progressive weakness, bowel or bladder problems, have a cancer history with new back pain, or are at risk for infection or fracture—don’t wait. Seek medical attention right away.
If you don’t have any of these red flags, work with your primary care provider on an appropriate treatment plan. They can guide you through conservative treatments and determine if and when you need to see a spine specialist.