Name two red flag symptoms that require urgent evaluation of neck pain.

• A. Fever and weight loss
• B. New bowel/bladder dysfunction
• C. Progressive weakness or gait disturbance
• D. New bowel/bladder dysfunction and progressive weakness or gait disturbance

Answer: (D)

The situation to watch for in neck pain is signs that suggest spinal cord compression. Two red flags that together signal urgent evaluation are new bowel or bladder dysfunction and progressive weakness or gait disturbance. New bowel/bladder changes mean autonomic pathways in the spinal cord may be affected, which is never normal when the neck is involved and can indicate compression or myelopathy. Progressive weakness or gait disturbance shows evolving impairment of the motor tracts, another hallmark of cord involvement. When both appear, the concern for significant cervical spine pathology that could rapidly worsen is high, so immediate imaging of the cervical spine (often an MRI) and urgent specialty evaluation are warranted to prevent lasting injury. Fever and weight loss point to infection or cancer risk, but they don’t directly imply acute cervical cord compromise without neurologic signs. New bowel/bladder dysfunction or progressive weakness alone are concerning, but the combination most strongly calls for urgent action.