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Cauda equina syndrome — MCCQE Part 1 MCQ

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ModerateBack PainCauda equina syndromeMCCQE Part 1

A 46-year-old man has severe low back pain radiating down both legs, urinary retention and saddle anaesthesia. Anal tone is reduced. Which of the following is the most appropriate next step?

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Correct answer: B — Emergency MRI and urgent spine surgical consultation

Bilateral radicular symptoms, urinary retention, saddle anaesthesia and reduced anal tone indicate cauda equina syndrome. Emergency MRI and decompression assessment are required to prevent permanent neurological injury. Routine conservative sciatica care is unsafe in the presence of red flags.

Reference: Canadian spine surgery/emergency medicine pathways; Choosing Wisely Canada imaging guidance