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Cauda equina syndrome — MCCQE Part 1 MCQ

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EasyBack PainCauda equina syndromeMCCQE Part 1

A 46-year-old woman presents with severe low back pain radiating down both legs. She reports new urinary retention and numbness around the perineum. Examination shows reduced anal tone and bilateral S1 weakness. What is the most appropriate next step in management?

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Correct answer: C — Arrange emergency MRI and urgent spine surgery consultation

Urinary retention, saddle sensory change, reduced anal tone and bilateral neurological findings indicate cauda equina syndrome. Emergency MRI and surgical consultation are required because delay can cause permanent bladder and neurological dysfunction. Plain x-ray and conservative therapy are inadequate for these red flags.

Reference: Choosing Wisely Canada; MCC Objectives—Back Pain