Traumatic spinal cord injury requires urgent imaging and decision-making involving a team approach. Causes of nontraumatic spinal cord injury are protean and can be roughly divided into compressive and non-compressive disease states. In general, it is the scenario of compressive spinal injury that needs to be identified quickly for possible urgent surgical decompression, whereas non-compressive injury requires a systematic work-up, which is somewhat less urgent. MRI is the imaging modality of choice for essentially all acute spinal cord disorders presenting to the ED, and the physician is charged with expeditious performance of this testing whenever spinal cord compression is deemed a likely possibility.

Multiple sclerosis (MS) is a common disorder, characterized by inflammatory lesions of the CNS (brain and spinal cord), affecting approximately 0.15% of the population in the United States. The disease has a peak incidence in the second and third decades of life, typically presenting in this age group as relapsing–remitting disease (RRMS). Patients with RRMS present to the emergency department (ED) with acute exacerbations of their illness, as well as “pseudorelapses” relating to concomittent illness, often febrile. Good recovery from attacks is typically seen following the initial attacks. Attack frequency decreases with time, but many patients begin to accumulate permanent disability within the first decade after onset. In patients over 40 years of age, the disease presents commonly as a slow primary progressive illness (PPMS). Approximately 10–15% of patients have PPMS.

This chapter presents different spinal pathologies and explains how to examine each case. The specific clinical tests and clinical signs are pointed out for each case. Cases covered include kyphosis, ankylosing spondylosis, cervical myelopathy, rheumatoid spine and spondylolisthesis, amongst others.

Examination of the adult spine follows a similar sequence for the cervical, thoracic and lumbar spines. The lumbar spine is emphasised in this chapter. The stepsinclude: Stand the patient and inspect. This is followed by palpation and then movement of the spine. Ask the patient to walk and then perform a complete neurological examination. With a cervical spine examination, the nerological examination is of the upper and lower limbs, whereas in the lumbar spine it is just the lower limb. For the thoracic spine, abdominal reflexes should also be performed.

This chapter covers disc disease including myelopathy in more detail. Other important conditions are also covered such as the bulbocavernosus reflex and tandem spinal stenosis.