- A.Bedrest and follow-up in 4 to 6 weeks
- B.Plain film X-ray of lumbosacral spine
- C.Sedimentation rate and complete blood count
- D.Immediate referral for surgical decompression
Answer is D.
This individual has cauda equine syndrome, and requires immediate surgical decompression to avoid long-term nerve denervation and incontinence/lower extremity weakness. The decreased anal sphincter tone and decreased ankle reflexes indicate a peripheral neuropathy.
Bedrest with follow-up is indicated when no “red flag” symptoms and signs are present.
The plain film X-ray is often normal in patients with cauda equine syndrome.
