A 68-year-old female presents to the Emergency Department (ED) with neck pain for 8 weeks. She denies any recent trauma but reports a history of breast cancer treated 5 years ago. She also notes mild, constant pain that is slightly worse at night. Which of the following risk factors for serious causes of neck and back pain is most concerning in this patient?

A 42-year-old male injection drug user (IDU) presents with fever, rigours, and new-onset, severe, unremitting mid-back pain that keeps him awake at night. He is unable to find a comfortable position.

A 75-year-old male with known severe rheumatoid arthritis slips and falls, landing on his shoulder. He reports immediate neck pain but no loss of consciousness.

A 35-year-old presents with acute, severe back pain and new-onset urinary incontinence over the last hour. Physical examination reveals perianal sensory loss and unexpected anal sphincter laxity.

A patient is taking warfarin (an anticoagulant) for atrial fibrillation. They present with acute, severe neck pain followed rapidly by progressive lower extremity weakness and gait disturbance.

A patient with neck pain reports a feeling of clumsy hands, a change in their gait, and difficulty with fine motor tasks. They deny a dermatomal pattern of pain radiation.

A patient presents with neck pain and a sharp, burning pain that radiates down their left arm to their thumb and index finger. They report paresthesias in the same distribution.

This distribution of pain and paresthesia, consistent with a specific nerve root, is the classic presentation of which cervical spine syndrome?

During a physical exam for neck pain, the clinician supports the patient's wrist and rapidly flicks the tip of the patient's middle finger downward. This results in an involuntary flexion of the patient's thumb and index finger. This positive manoeuvre is known as Hoffman's sign and indicates pathology in which region of the nervous system?

A patient with chronic neck pain undergoes an exam where the clinician presses down on the patient's head while the neck is in extension and leaned toward the symptomatic side. This manoeuvre elicits sharp pain radiating down the arm. This positive finding is known as Spurling’s sign and is highly specific for which underlying cause of neck and arm pain?

A patient with neck pain experiences a sudden, electric shock-like sensation radiating down their spine into both arms when they flex their neck forward (chin to chest). This finding, known as Lhermitte’s sign, is indicative of which general pathological process?

A 40-year-old patient presents with acute (5 days duration), atraumatic, non-radiating, non-myelopathic neck pain that began after "sleeping funny." The physical exam is otherwise normal. What is the most appropriate initial diagnostic step for acute, uncomplicated neck pain?

A 55-year-old male with chronic neck pain and new, subtle signs of myelopathy (gait disturbance, hyperreflexia) has plain cervical X-rays showing mild degenerative changes but no obvious fracture. Based on these findings, which imaging study is indicated next?

A patient presents with chronic neck pain and a new, progressive weakness in their triceps muscle , along with a reduced triceps reflex.Which of the following cervical spine levels is the most likely site of the nerve root lesion responsible for these specific motor and reflex findings?

A 60-year-old male with long-standing cervical spondylosis develops new-onset difficulty swallowing (dysphagia). The dysphagia is most likely caused by osteophytic spurs encroaching on which structure?

A 50-year-old patient has a strong suspicion for a spinal epidural abscess but has a cardiac pacemaker. What is the recommended imaging modality for the spine?

A 30-year-old patient with acute, uncomplicated mechanical neck pain (whiplash injury from an MVA) asks for a soft cervical collar, believing it will speed up recovery. What is the best advice regarding the use of a soft collar for this condition?

A patient presents with acute cervical radiculopathy (pain radiating down the arm) with no signs of myelopathy. Which of the following is an accepted first-line treatment for cervical radiculopathy in the absence of myelopathy?

A 58-year-old patient has chronic neck pain with mild radiculopathy. They have failed trials of NSAIDs, muscle relaxants, and physical therapy. Imaging confirms degenerative changes.

Question: Which intervention may be considered for chronic cervical radiculopathy when other conservative treatments have failed?

A patient with long-standing cervical spondylosis is diagnosed with cervical myelopathy. The definitive management recommendation for a patient with symptoms and signs of cord compression is:

A patient with acute cervical radiculopathy initially responded to conservative care, but now presents with rapidly progressive C7 distribution weakness.

Question: Which of the following is an indication for hospital admission in a patient with cervical radiculopathy?

A 35-year-old male presents to the clinic with low back pain that began 3 weeks ago after lifting a heavy box. The pain is dull, aching, worsens with movement, and improves with rest. He denies fever, weight loss, or neurologic symptoms. Physical examination is unremarkable, and a straight leg raise test is negative.

What is the most appropriate initial management for this patient?

A 42-year-old active woman presents with severe right leg pain radiating below the knee, in addition to moderate lower back pain. Her symptoms started 2 days ago after a sudden twist. She reports increased pain when sitting or coughing and relief when lying supine. The straight leg raise test is positive on the right, reproducing her radicular pain. She has no fever, weakness, or bowel/bladder changes.

Given the most likely diagnosis, which nerve root is most commonly impinged in disk herniation?

A 70-year-old man reports chronic low back pain and bilateral leg discomfort. He finds that walking for short distances or prolonged standing brings on a dull, aching pain in his legs, which is quickly relieved when he sits down and leans forward (e.g., resting on a shopping cart).What is the term for the leg pain this patient is experiencing?

A 68-year-old woman with a history of chronic steroid use for rheumatoid arthritis presents with a new, acute onset of back pain after simply bending over to tie her shoe. She reports no fever or neurologic deficits.

Which serious cause of back pain is specifically suggested by her age and medical history?

During an examination for lower back pain, a physician performs a straight leg raise test. When lifting the patient's symptomatic leg, the patient reports pain in their hamstring and buttock area, but it does not radiate below the knee.

How should this result be interpreted?

Which combination of pain features is most concerning and suggestive of a serious underlying condition like tumor or infection?

A 55-year-old male with a known history of prostate cancer and recent back pain develops acute urinary incontinence and saddle anesthesia (numbness over the buttocks and perineum).

What is the most serious and likely diagnosis in this patient?

A patient is admitted with fever, severe point tenderness to percussion over a vertebral body, and an elevated erythrocyte sedimentation rate (ESR). A spinal infection (e.g., vertebral osteomyelitis or epidural abscess) is suspected.

What is the gold standard imaging study in this scenario?

A 40-year-old patient presents with 3 weeks of persistent back pain, night sweats, and a low-grade fever. Which of the following from the patient's history would be the most significant risk factor for a spinal infection (e.g., spinal epidural abscess)?

A patient presents with acute onset of back pain and bilateral lower extremity weakness. An epidural compression syndrome from a metastatic tumor is suspected. What immediate intervention should be considered before confirmatory imaging?