The human nervous system contains more than 100 billion neurons. Each has a unique function enabling taste, smell, touch, sight, hearing, movement, respiration, cognition, and much more. In the setting of a neurologic emergency, patients may lose these unique capacities. It is the emergency physician’s responsibility to complete a neurologic history and examination to determine the type of deficit and the neuroanatomical location of the abnormality

Principles of anatomy relevant to radiculopathy are discussed. Spondylotic pathology is proximal to the dorsal root ganglia (DRG). As a result DRG axons to the periphery are unaffected. This topography means that sensory radicular symptoms are unaccompanied by abnormality on sensory nerve conduction studies. Due to regional differences in the angulation of the intervertebral foramina, sagittal MRI images are better for demonstrating foraminal stenosis in the lumbar than in the cervical region. Myotomes and dermatomes vary between individuals.

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.