Spinal Emergencies
A 42-year-old man presents to the emergency department at 11pm with severe lower back pain, bilateral leg pain, and difficulty urinating since that morning. He describes altered sensation when wiping after bowel movements. Examination reveals reduced perianal sensation and decreased anal tone on digital rectal examination. Bladder scan shows 600ml post-void residual. MRI demonstrates a large central L4/5 disc herniation compressing the cauda equina. The on-call spine surgeon discusses the classification of cauda equina syndrome and the urgency of surgical decompression. Regarding cauda equina syndrome diagnosis and management:
Mark each as TRUE or FALSE
Cauda equina syndrome (CES) is compression of nerve roots L2-S5 below the conus medullaris; the GLEA...
Red flags include bilateral sciatica, saddle ANAESTHESIA, reduced ANAL TONE, bladder dysfunction, an...
CES-R (Retention) has a BETTER prognosis than CES-I; urinary symptoms are a late and unreliable sign...
Surgery should be performed AS SOON AS SAFELY POSSIBLE; CES-I patients have significantly BETTER out...
Emergency MRI is MANDATORY if red flags present (day or night); the procedure is wide decompressive ...
Answer the questions to see explanations
Click T (True) or F (False) for each option