A 50-year-old male presents with acute severe back pain after lifting a heavy object. He has bilateral leg weakness (MRC grade 3/5), urinary incontine...

Question

A 50-year-old male presents with acute severe back pain after lifting a heavy object. He has bilateral leg weakness (MRC grade 3/5), urinary incontinence, and reduced perianal sensation. What is the single most important investigation and what is the urgency?

Accepted Answer

Emergency MRI spine - cauda equina syndrome is a surgical emergency requiring decompression within hours

Answer

No investigation needed - mechanical back pain with psychological overlay

Answer

Plain lumbar X-ray within 48 hours

Answer

CT abdomen to exclude AAA

Answer

Nerve conduction studies as an outpatient

uk-dipimc MCQ (SBA): Cauda Equina Syndrome - Investigation

A 50-year-old male presents with acute severe back pain after lifting a heavy object. He has bilateral leg weakness (MRC grade 3/5), urinary incontinence, and reduced perianal sensation. What is the single most important investigation and what is the urgency?