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A doctor should evaluate any back pain in these cases:

• Any elderly person
• A person with cancer
• Anyone whose pain is exactly the same at rest as it is during activity
• A person with unintentional weight loss

Seek medical help at a hospital's emergency department if you have the following symptoms in association with back pain:

• Loss of control of urine or defecation
• Severe pain, numbness, or weakness
• High fever

The diagnosis of vertebral compression fractures is usually straightforward. Regular X-rays are obtained. Then a physical examination is performed to correlate the location of pain and tenderness with the level of the compression fracture and to exclude the presence of focal neurologic deficit or myelopathy.

Most often, the radiographic diagnosis of compression fracture is made by using plain-film radiographs of the spine. Magnetic resonance imaging (MRI) is essential in identifying cord compression as a consequence of a posteriorly displaced or retropulsed bone fragment. MRI findings are most informative in evaluating the spine at the levels where the spinal cord is present (e.g., from the cervical spine through the second lumbar vertebra). Computed tomographic (CT) is the most sensitive means of identifying a linear fracture through the posterior vertebral cortex.

Nuclear medicine bone scanning is helpful in assessing metastatic disease and when pain is elicited on palpation at levels other than where a fracture is radiographically identified. The required imaging studies include CT evaluation for fractures of the lumbar spine and both CT and MRI for fractures of the cervical and thoracic spine.

Age should never preclude treatment.

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