Back pain is very common. Most of the time, back pain is muscular and gets better on its own; but sometimes it does not. As a spine surgeon, I will always be on the aggressive side with regards to diagnostic modalities. I believe that in 2018, we have an opportunity to know instead of just think. With the use of advanced imaging and other diagnostic tools, one can be certain that back pain is not a sign of something scary. Something scary is rare but when it happens, it needs to be addressed as quickly and efficiently as possible.

Some things to look out for include:
Recent Unwanted Weight Loss: I always ask this question of my patients and 99% of the times, the answer is laughingly, “I wish”; but if you are not trying to lose weight and you find that your pants are becoming loose or that your face is changing in the mirror, I would seek medical advice.

Nighttime Pain:
Nighttime pain is generally a sign of inflammation, but so can cancer. I would perform advanced imaging on any patient who complains of nighttime pain.

Fevers and Chills:
This is a common sign of infection and when it occurs in conjunction with back pain, I would have it further evaluated.

Incontinence is a very common finding and it is important to note that at most times, incontinence is not associated with spinal pathology. However, when incontinence is associated with groin numbness or when incontinence occurs suddenly in association with back pain, that is a big red flag that should be evaluated right away.

Red flags in association with back pain are rare but when they are there they should not be ignored. This includes again, recent unwanted weight loss, fevers and chills, incontinence and nighttime pain.

Georgiy Brusovanik, M.D.