Spinal Compression: When to See a Neurosurgeon or Rehab Specialist

Spinal compression

Hello, doctor.
My mother fell on her buttocks at the beginning of February and experienced incontinence and inability to move.
After an X-ray in the emergency department, it was determined that she had a spinal compression and needed to rest.
If her condition did not improve, she was advised to see an outpatient clinic.
Since her condition improved, she did not seek further medical attention until the end of March when she fell straight off the toilet while using it and again had difficulty moving.
In mid-April, she visited another hospital's orthopedic outpatient clinic, where new X-rays were taken.
However, the physician reviewed both the previous and current X-rays and stated that there were no abnormalities and no signs of spinal compression.
Should she have seen a different specialty, such as neurosurgery or rehabilitation medicine? Thank you.

VICKY, 40~49 year old female. Ask Date: 2023/04/18

Dr. Zhao Shaoqing reply Neurosurgery

You can consult a neurologist for evaluation.

Reply Date: 2023/04/18

More Info

When it comes to spinal compression and related symptoms, understanding when to consult a neurosurgeon or a rehabilitation specialist is crucial for effective management and recovery. Your mother's situation, involving a fall that resulted in significant symptoms such as incontinence and immobility, raises several important considerations.

Firstly, spinal compression can occur due to various reasons, including trauma, degenerative disc disease, herniated discs, or tumors. In your mother's case, the initial assessment indicated spinal compression following her fall, which is a serious condition that can lead to neurological deficits if not properly addressed. The symptoms of incontinence and inability to move are particularly concerning, as they may indicate involvement of the spinal cord or nerve roots.

After the initial incident, it appears that your mother experienced some improvement, which is a positive sign. However, the subsequent fall and the inability to get up afterward suggest that there may still be underlying issues that need to be evaluated. The fact that a second opinion from an orthopedic specialist did not reveal any abnormalities on X-rays is noteworthy. X-rays can sometimes miss subtle issues, especially those related to soft tissues or nerve compression, which may require advanced imaging techniques like MRI or CT scans for a more comprehensive evaluation.

Given the complexity of spinal issues, it is advisable to consider a referral to a neurosurgeon. Neurosurgeons specialize in conditions affecting the nervous system, including the spine, and are well-equipped to assess and manage spinal compression. They can provide a thorough evaluation, including the potential need for advanced imaging studies to visualize the spinal cord and nerve roots more clearly. If there is evidence of significant compression or other neurological concerns, a neurosurgeon can discuss surgical options or other interventions that may be necessary.

On the other hand, a rehabilitation specialist, such as a physiatrist, focuses on restoring function and improving quality of life through non-surgical means. If your mother is stable and the primary concern is rehabilitation after her injuries, a rehab specialist can develop a tailored program that includes physical therapy, pain management, and strategies to improve mobility and strength. This approach can be beneficial if the primary goal is to regain function and manage symptoms without immediate surgical intervention.

In summary, if your mother continues to experience significant symptoms or if there are concerns about her neurological status, it would be prudent to consult a neurosurgeon for a comprehensive evaluation. If her condition stabilizes and the focus shifts to rehabilitation, a referral to a rehabilitation specialist may be appropriate. It’s essential to ensure that her care is coordinated and that all specialists involved are aware of her medical history and current symptoms. This collaborative approach can lead to better outcomes and a more effective management plan for her spinal health.

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