Apart from cauda equina other spinal emergencies include trauma, tumour and infection. For fractures, early management involves maintaining spinal alignment to prevent damage/further damage to the spinal cord.
Whilst spinal infection and tumours are obviously spinal 'urgencies' and suspicion should prompt an urgent referral (see 'red-flags'), they are only considered emergencies when there is evidence of spinal cord compression. Presentation will usually be with progressively worsening back pain and early lower limb +/- upper limb neurological symptoms. Patients will usually complain of altered sensation in the lower limbs, subjective weakness, possibly ataxia, possibly sciatica and mild bladder symptoms. These early symptoms are likely to progress to more marked weakness which is often only detectable on clinical testing when the patient is no longer able to walk.
Early clinical signs of spinal cord compression include: positive Romberg's sign (patient becomes very unsteady when they close their eyes), ankle clonus, brisk reflexes, extensor plantar reflexes. The treatment of these patients involves urgent assessment and where possible, decompression of the spinal cord and stabilisation of the spine with instrumentation. If this surgery is done when the patient is unable to walk, only a 33% will walk a month later, hence the need for early symptom detection and urgent referral if spinal cord compression is suspected.