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A 32-year-old woman presents to the emergency department with two days of worsening back and leg pain after feeling a sharp pop in her low back after an episode of coughing. She complains of numbness in her perianal region and bilateral buttocks that she notices when wiping herself with toilet paper after urinating. She also reports she is having difficulty urinating and had some episodes of incontinence. She complains of bilateral leg pain that is worse on the left in the region of the anterolateral calf. On physical exam she has weakness to big toe extension of 3/5 and is unable to walk on her heels with the toes elevated. MRI of her spine is shown in figures A through C. After surgical intervention, which of her symptoms is least likely to improve?
Big toe extension weakness
Loss of perianal sensation
Numbness in the left foot
Burning pain in left leg
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A 56-year-old man with a history of chronic lower back pain from lumbar spondylosis reports a 2-day history of acute incapacitating back pain. He denies any history of acute trauma, although he reports the pain starting after a coughing spell. He also reports difficulty urinating and some fecal incontinence. Examination reveals generalized lower extremity weakness, saddle paresthesia, hyporeflexia in the lower extremities, and loss of rectal tone. What is the most appropriate management at this time?
Immediate MRI of the lumbar spine
General reassurance, anti-inflammatory drugs, and an early home exercise program
Immediate radiographs of the lumbar spine and pain medications with 2 days of bed rest if the radiographs are normal
Office caudal epidural steroid injection with follow-up in 1 week
Outpatient MRI of the lumbar spine with follow-up in 1 week for test results
A 49-year-old male presents with saddle anesthesia, lower extremity weakness, and urinary retention. When must surgical decompression be done to improve bladder and motor recovery?
less than 24 hours after symptom onset
less than 48 hours after symptom onset
less than 60 hours after symptom onset
less than one week after symptom onset
less than two weeks after symptom onset
A 51-year-old male with a pacemaker reports difficulty with urination and numbness in his bilateral buttock. His symptoms began 12 hours ago. What is the next most appropriate step in management?
MRI of the lumbar spine
CT myelogram of the lumbar spine
Epidural steroid injection
Emergent lumbar decompression
High dose methylprednisone