Non-traumatic cervical disc prolapse with spinal cord compression: an unlikely but important cause of leg and back pain

British Journal of General Practice, 2018 · DOI: https://doi.org/10.3399/bjgp18X696581 · Published: June 1, 2018

Simple Explanation

Leg pain, back pain, and unsteadiness are common presenting complaints in general practice that can represent a broad range of conditions. Rarely, they can be the first symptoms of catastrophic spinal cord lesions. This report explores a case of cervical spondylomyelopathy resulting in severe spinal cord compression and impending paraplegia that presented in the community with mild initial symptoms and no history of trauma. The case was referred to the medical team on call to investigate possible central or spinal cord lesions secondary to malignancy, infection, metabolic or neurological disorders.

Study Duration

Not specified

Participants

A 42-year-old male

Evidence Level

Case Report

Key Findings

1
A previously well and active 42-year-old male presented to his GP with a 4-week history of persistent ‘burning’, ‘stretching’ pain in both thighs and vague, non-radiating lower back pain. He also complained of progressive unsteadiness on his feet.
2
MRI of the whole spine revealed disc herniation at the level of C6/C7 causing severe spinal cord compression.
3
It is worth noting that neither neck pain nor upper-limb symptoms were present despite the site and severity of the underlying cervical lesion.

Research Summary

This case demonstrates how the common presenting complaints of leg pain and back pain, even in the absence of trauma, should prompt focused assessment and a low threshold for investigation to rule out lesions of the spinal cord. Early paraparesis in the absence of traumatic injury can be difficult to diagnose in a primary care setting as symptoms may be vague. Focused history and recognition of abnormal neurological signs by focused physical examination is crucial to preventing devastating morbidity.

Practical Implications

Prompt Investigation

Leg and back pain, even without trauma, should prompt investigation for spinal cord lesions.

Neurological Examination

Unsteadiness warrants a neurological examination.

Safety-Net Advice

Provide clear safety-net advice and follow-up for unrelenting symptoms.

Study Limitations

1
Single case report limits generalizability
2
Impossible to determine the duration of the disc herniation
3
Vague symptoms can delay diagnosis

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury