E01 · published 10 Nov 2026
The Back Pain That Can Kill You
Every factual claim in this video, when it is said, the study or guideline behind it, and how strong that evidence is. Watch the video on YouTube.
How to read this: a guideline or systematic review is the strongest evidence; an observational study or expert opinion is weaker, and the video says so where it matters. More on evidence levels.
Claims and their evidence (42)
| When | What the video says | Source | Evidence |
|---|---|---|---|
| 0:19 | But for every hundred and twenty-five people who see a family doctor about back pain, about one has a serious problem in their spine. | Reginato, Pain Medicine 2026 [1] | Guideline / systematic review |
| 0:27 | Back pain is the number one cause of disability on the planet. | Hartvigsen, The Lancet 2018 [2] | Observational study |
| 0:31 | It's incredibly common. | Hartvigsen, The Lancet 2018 [2] | Observational study |
| 0:38 | A few rare causes can leave you unable to walk, or control your bladder. A few can kill you. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] Budiman, Emergency Medicine Australasia 2026 [7] Fernando, Academic Emergency Medicine 2022 [16] | Guideline / systematic review |
| 0:45 | And they're often missed at first, because they start out looking like ordinary back pain. | Budiman, Emergency Medicine Australasia 2026 [7] Davis, Journal of Emergency Medicine 2004 [9] Azhar, Journal of Endovascular Therapy 2014 [15] | Guideline / systematic reviewObservational study |
| 1:17 | In adults, it ends around the top of the lower back. That's Latin for "horse's tail. These nerves run your legs, bladder, bowel and sexual function. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] | Expert opinion |
| 1:38 | Most of the time, it's burnt toast: a lot of noise, but no real danger. Loud, miserable, and usually harmless. | Reginato, Pain Medicine 2026 [1] Hartvigsen, The Lancet 2018 [2] | Guideline / systematic reviewObservational study |
| 1:46 | For nearly everyone with back pain, doctors can't point to one specific cause. | Hartvigsen, The Lancet 2018 [2] | Observational study |
| 1:51 | And on average, people improve a lot within about six weeks. | da C Menezes Costa, CMAJ 2012 [3] | Guideline / systematic review |
| 2:21 | Something, often part of a disc pushing backward, is squeezing that bundle of nerves. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] | Guideline |
| 2:34 | Estimates range from about one to three in a hundred thousand people a year. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] Woodfield, Neuroepidemiology 2022 [5] | GuidelineObservational study |
| 2:39 | But it can permanently affect your bladder, bowel, legs and sex life. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] | Guideline |
| 2:44 | Doctors treat it as an emergency. In the UK, the standard is a scan within four hours of the request. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] | Guideline |
| 2:58 | In this story, you might have had a skin infection, a drip in your arm, or diabetes. Bacteria have settled in the space around your nerves, and a pocket of pus slowly builds up. | Budiman, Emergency Medicine Australasia 2026 [7] Reihsaus, Neurosurgical Review 2000 [8] Galliker, American Journal of Medicine 2020 [10] | Guideline / systematic review |
| 3:18 | In one study, the textbook trio showed up at the first visit in only about one in eight patients. | Davis, Journal of Emergency Medicine 2004 [9] | Observational study |
| 3:28 | In that same study, three in four had a delayed diagnosis. | Davis, Journal of Emergency Medicine 2004 [9] | Observational study |
| 3:33 | And across many studies, about one in ten people with this infection died. | Budiman, Emergency Medicine Australasia 2026 [7] | Guideline / systematic review |
| 3:42 | If you've ever had cancer, new back pain deserves a doctor's look the same day. Same day, too, if you've had cancer and get new or worsening back pain. | NICE NG234, 2023 [12] | Guideline |
| 3:47 | A past history of cancer is one of the few single clues that really helps. | Verhagen, Pain 2017 [11] | Guideline / systematic review |
| 3:52 | Pain that keeps getting worse, wakes you at night, or flares when you cough or strain makes it more worrying. | NICE NG234, 2023 [12] | Guideline |
| 3:59 | If the cancer presses on the spinal cord, legs can weaken and walking gets harder. | NICE NG234, 2023 [12] | Guideline |
| 3:59 | If the cancer presses on the spinal cord, legs can weaken and walking gets harder. That's an emergency. And if you've had cancer, new leg weakness or trouble walking means go now. | NICE NG234, 2023 [12] | Guideline |
| 4:09 | If you're over seventy, have taken steroid medicines for a long time, or had a real fall, a vertebra may crack. | Han, Cochrane Database of Systematic Reviews 2023 [13] | Guideline / systematic review |
| 4:17 | When bones are weak, it can take surprisingly little force. | Textbook knowledge or clinical consensus, checked by the reviewing doctor | Expert opinion |
| 4:22 | One emergency department study looked at a thousand people with back pain. Serious causes outside the spine turned up more often than serious causes inside it. | Shaw, European Spine Journal 2020 [14] | Observational study |
| 4:37 | The most dangerous is the aorta, your body's main artery, which runs right in front of your spine. If it bursts or tears, it's life-threatening. | Fernando, Academic Emergency Medicine 2022 [16] Lovatt, American Journal of Emergency Medicine 2022 [17] | Guideline / systematic reviewExpert opinion |
| 4:47 | A burst aneurysm, a ballooned section of the aorta, is first mistaken for something else in about one in three cases. | Azhar, Journal of Endovascular Therapy 2014 [15] Lovatt, American Journal of Emergency Medicine 2022 [17] | Guideline / systematic review |
| 4:59 | You don't need all of them. One is enough. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] | Guideline |
| 5:02 | Go to an emergency department now if back pain comes with any of these: new trouble peeing, or not feeling when your bladder is full. Numbness in the "saddle" area: between your legs, around your bottom, your genitals or your inner thighs. Losing control of your bowels. A new change in sexual function. Or weakness or numbness in your legs that's getting worse. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] Hennessy, European Spine Journal 2025 [6] NICE NG234, 2023 [12] | Guideline / systematic review |
| 5:26 | Go now, too, with sudden, severe pain in your back or belly, especially if you feel faint. | Fernando, Academic Emergency Medicine 2022 [16] | Guideline / systematic reviewExpert opinion |
| 5:37 | See a doctor the same day if your back pain comes with a fever, or you feel generally unwell. | Galliker, American Journal of Medicine 2020 [10] Shaw, European Spine Journal 2020 [14] | Guideline / systematic reviewObservational studyExpert opinion |
| 5:55 | See a doctor soon for pain after a fall if you're over seventy, or take long-term steroids. | Han, Cochrane Database of Systematic Reviews 2023 [13] | Guideline / systematic reviewExpert opinion |
| 6:01 | And pain in your side with a fever, or pain when you pee, may be your kidneys. Get that checked the same day. | Shaw, European Spine Journal 2020 [14] | Observational studyExpert opinion |
| 6:10 | No single warning sign proves anything. | Han, Cochrane Database of Systematic Reviews 2023 [13] Finucane, Journal of Orthopaedic & Sports Physical Therapy 2020 [18] Henschke, Cochrane Database of Systematic Reviews 2013 [23] | Guideline / systematic review |
| 6:13 | In one study, eight in ten people with back pain had at least one so-called red flag. Fewer than one in a hundred had something serious. | Henschke, Arthritis & Rheumatism 2009 [19] | Observational study |
| 6:22 | Most warning signs come from small studies. | Galliker, American Journal of Medicine 2020 [10] Han, Cochrane Database of Systematic Reviews 2023 [13] Finucane, Journal of Orthopaedic & Sports Physical Therapy 2020 [18] | Guideline / systematic review |
| 6:25 | The go-now signs are the ones emergency guidelines name. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] NICE NG234, 2023 [12] Fernando, Academic Emergency Medicine 2022 [16] | Guideline |
| 6:31 | Disc bulges show up in about three in ten pain-free twenty-year-olds, and more than eight in ten by age eighty. | Brinjikji, AJNR American Journal of Neuroradiology 2015 [20] | Guideline / systematic review |
| 6:39 | Even a herniated disc often shrinks on its own. | Chiu, Clinical Rehabilitation 2015 [21] | Guideline / systematic review |
| 6:42 | That's why most people don't need a scan. | NICE NG59, 2016, updated 2026 [22] | Guideline |
| 6:45 | If you're worried, or your pain isn't settling, see your doctor. | Textbook knowledge or clinical consensus, checked by the reviewing doctor | Expert opinion |
| 6:53 | But bladder or bowel trouble, a numb saddle, weakening legs, or sudden severe pain mean go now. Fever, or new back pain after cancer, means today. | GIRFT, National Suspected Cauda Equina Syndrome Pathway 2023 [4] Hennessy, European Spine Journal 2025 [6] Galliker, American Journal of Medicine 2020 [10] NICE NG234, 2023 [12] Shaw, European Spine Journal 2020 [14] Fernando, Academic Emergency Medicine 2022 [16] | Guideline / systematic reviewExpert opinionObservational studyGuideline |
All sources (23)
- Reginato LS et al. Prevalence of serious spinal pathologies and nonspinal conditions in low back pain: a systematic review and meta-analysis. Pain Medicine. 2026. doi.org/10.1093/pm/pnaf078
- Hartvigsen J et al. What low back pain is and why we need to pay attention. The Lancet. 2018. doi.org/10.1016/S0140-6736(18)30480-X
- da C Menezes Costa L et al. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012. doi.org/10.1503/cmaj.111271
- Getting It Right First Time (GIRFT). National Suspected Cauda Equina Syndrome Pathway. 2023. spinal.co.uk/wp-content/uploads/2023/08/National-Suspected-Cauda-Equina-Pathway-February-2023-FINAL-V1-1.pdf
- Woodfield J et al. Demographics of cauda equina syndrome: a population-based incidence study. Neuroepidemiology. 2022. doi.org/10.1159/000527727
- Hennessy O et al. Assessment and early investigation of cauda equina syndrome: a systematic review of existing international guidelines. European Spine Journal. 2025. doi.org/10.1007/s00586-025-08732-0
- Budiman L et al. Clinical characteristics of patients with spinal epidural abscess: a systematic review and meta-analysis. Emergency Medicine Australasia. 2026. doi.org/10.1111/1742-6723.70204
- Reihsaus E et al. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurgical Review. 2000. doi.org/10.1007/pl00011954
- Davis DP et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. Journal of Emergency Medicine. 2004. doi.org/10.1016/j.jemermed.2003.11.013
- Galliker G et al. Low back pain in the emergency department: prevalence of serious spinal pathologies and diagnostic accuracy of red flags. American Journal of Medicine. 2020. doi.org/10.1016/j.amjmed.2019.06.005
- Verhagen AP et al. Most red flags for malignancy in low back pain guidelines lack empirical support: a systematic review. Pain. 2017. doi.org/10.1097/j.pain.0000000000000998
- NICE. Spinal metastases and metastatic spinal cord compression (NG234). 2023. www.nice.org.uk/guidance/ng234
- Han CS et al. Red flags to screen for vertebral fracture in people presenting with low back pain. Cochrane Database of Systematic Reviews. 2023. doi.org/10.1002/14651858.CD014461.pub2
- Shaw B et al. Back pain "red flags": which are most predictive of serious pathology in the emergency department? European Spine Journal. 2020. doi.org/10.1007/s00586-020-06452-1
- Azhar B et al. Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis. Journal of Endovascular Therapy. 2014. doi.org/10.1583/13-4626MR.1
- Fernando SM et al. Accuracy of presenting symptoms, physical examination, and imaging for diagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis. Academic Emergency Medicine. 2022. doi.org/10.1111/acem.14475
- Lovatt S et al. Misdiagnosis of aortic dissection: a systematic review of the literature. American Journal of Emergency Medicine. 2022. doi.org/10.1016/j.ajem.2021.11.047
- Finucane LM et al. International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic & Sports Physical Therapy. 2020. doi.org/10.2519/jospt.2020.9971
- Henschke N et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis & Rheumatism. 2009. doi.org/10.1002/art.24853
- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology. 2015. doi.org/10.3174/ajnr.A4173
- Chiu CC et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation. 2015. doi.org/10.1177/0269215514540919
- NICE. Low back pain and sciatica in over 16s: assessment and management (NG59). 2016, updated 2026. www.nice.org.uk/guidance/ng59
- Henschke N, Maher CG, Ostelo RWJG, de Vet HCW, Macaskill P, Irwig L. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database of Systematic Reviews. 2013. doi.org/10.1002/14651858.CD008686.pub2
Corrections
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