Question

A 49-year-old man presents with saddle anaesthesia, urinary retention and severe low back pain with bilateral leg weakness. Which is the most appropriate next step?

Accepted Answer

Urgent MRI of the lumbosacral spine and neurosurgical consultation

Answer

Order lumbar spine plain X-rays and arrange physiotherapy

Answer

Start opioids and review in clinic in one week

Answer

Refer for chiropractic manipulation

Answer

Reassure that this is mechanical back pain and encourage exercise

Practice question

A 49-year-old man presents with saddle anaesthesia, urinary retention and severe low back pain with bilateral leg weakness. Which is the most appropriate next step?