When Back Pain Becomes an Emergency — Our First Vertera Live Guest Expert Session

On Thursday evening we hosted our first guest expert session on Vertera Live, and what a way to start. Huge thank you to Mr David Cumming for giving up his evening to talk so openly about a topic that most people only hear about when it is already happening to them.

Dave is a Consultant Spinal Surgeon at the Cleveland Clinic London and the East Suffolk and North Essex NHS Trust. We have worked together for many years, shared patients and clients, and I knew he would be the right person for this. He has a way of explaining complex surgical topics that actually makes sense to a non-surgeon.

What We Covered

The session focused on cauda equina syndrome — a rare but serious condition where the nerves at the base of the spine become compressed, usually by a large disc prolapse. If not treated quickly, the damage can be permanent.

Illustration of cauda equina nerve compression at the base of the spine.

Dave walked through the warning signs: sudden onset severe back pain, pain radiating down both legs, and any changes to bowel, bladder or sensation in the saddle area. He was clear that when these symptoms appear together, hours matter.

We talked about what should happen when you present at A&E with suspected cauda equina. The gold standard investigation is an MRI, not an X-ray. An X-ray only shows bone and will not reveal a disc compressing your nerves. A lot of patients do not know this, and it can make the difference.

Advocating for Yourself

One of the most useful parts of the conversation was around patient advocacy. As a patient, you are within your rights to ask questions. Why am I having this test? Why not an MRI? And if you do not feel listened to, you can ask for a second opinion or a more senior review.

If you are discharged but your symptoms change, go back. Do not feel like you are bothering anyone. That is what the system is there for. I will be honest — I did not know patients could ask for a senior review in A&E, and I found that really helpful to hear from Dave directly.

Beyond Cauda Equina

We also covered other conditions that can present as spinal emergencies. Spinal infections, particularly in older or immunocompromised patients, can cause deep-seated pain that is easy to miss. And cancer metastases, sometimes years after the original diagnosis, can show up first as back pain. If you have a history of cancer and develop new or worsening back pain, make sure your medical team knows.

Audience Questions

We had brilliant questions coming in throughout. Everything from risk factors for disc bulges, to how cauda equina presents differently in older patients with stenosis, to whether a single episode of incontinence without other symptoms warrants a trip to A&E. It really added to the session and Dave gave proper, considered answers to each one.

Watch the Replay

If you missed the live session, the full replay is now available in the Vertera app. Head to the Learn tab, All Modules and search for “live”.

If you are not yet a Vertera member, you can start a free trial to watch the full session along with all of our exercise tutorials, recovery programmes, and educational content.

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We are really excited about this series and already have our next guest lined up. Details to follow shortly. If you would like to hear about future live sessions, make sure you are signed up to our newsletter.