When is transfer indicated for the treatment of mechanical back pain?

Updated: Aug 27, 2020
  • Author: Debra G Perina, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Time-sensitive transfer to other facilities may be necessary in patients with suspected or known cauda equina syndrome or epidural hematoma or abscess, or if emergent MRI or a needed consultant is not available at the treating hospital. All suspected cauda equina patients should receive dexamethasone before transfer. Suspected or known epidural abscess patients should receive empiric antibiotics against staphlococcus, streptococcus, and gram-negative bacilli; and in suspected or known epidural hematomas in patients on anticoagulants, the anticoagulant agent should be reversed if possible before transport to avoid delays in treatment.

Patients with compressive tumors or abscesses should be transferred to a center that has a spine surgeon who can provide decompression in a timely manner if unavailable at the treating hospital.


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