Spinal Emergencies in Primary Care Practice

Am J Med. 2019 Mar;132(3):300-306. doi: 10.1016/j.amjmed.2018.09.022. Epub 2018 Oct 3.


Atraumatic spinal emergencies often present a diagnostic and management dilemma for health care practitioners. Spinal epidural abscess, cauda equina syndrome, and spinal epidural hematoma are conditions that can insidiously present to outpatient medical offices, urgent care centers, and emergency departments. Unless a high level of clinical suspicion is maintained, these clinical entities may be initially misdiagnosed and mismanaged. Permanent neurologic sequela and even death can result if delays in appropriate treatment occur. A focused, critical review of 34 peer-reviewed articles was performed to identify current data about accurate diagnosis of spinal emergencies. This review highlights the key features of these 3 pathological entities with an emphasis on appropriate diagnostic strategy to intervene efficiently and minimize morbidity.

Keywords: Cauda equina syndrome; Spinal emergencies; Spinal epidural abscess; Spinal epidural hematoma.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Blood Coagulation Disorders / complications
  • Blood Coagulation Disorders / diagnosis
  • Blood Coagulation Disorders / therapy
  • Cauda Equina Syndrome / diagnosis*
  • Cauda Equina Syndrome / therapy
  • Debridement
  • Decompression, Surgical
  • Delayed Diagnosis / prevention & control
  • Diagnosis, Differential
  • Diagnostic Errors / prevention & control
  • Emergencies*
  • Epidural Abscess / diagnosis*
  • Epidural Abscess / therapy
  • Hematoma, Epidural, Spinal / diagnosis*
  • Hematoma, Epidural, Spinal / etiology
  • Hematoma, Epidural, Spinal / therapy
  • Humans
  • Magnetic Resonance Imaging
  • Myelography
  • Primary Health Care*
  • Sciatica / diagnosis
  • Tomography, X-Ray Computed


  • Anti-Bacterial Agents