A 35-year-old presents with acute onset low back pain radiating to the right leg along L5 distribution (great toe dorsiflexion weakness, foot drop) after lifting a heavy object. MRI confirms L4–L5 right posterolateral disc herniation. He fails conservative therapy for 6 weeks. Indications for urgent (emergency) surgical discectomy include:
- A Persistent radiculopathy without neurological deficit for >6 weeks
- B VAS pain score >8/10 despite analgesics
- C Cauda equina syndrome (bladder/bowel dysfunction, perineal numbness, bilateral leg weakness) ✓
- D MRI showing large disc herniation even without symptoms
Explanation
Cauda equina syndrome — presenting with urinary retention or incontinence, fecal incontinence, perineal/saddle anesthesia, and bilateral leg weakness/sensory loss — is a surgical emergency requiring urgent discectomy within 24–48 hours to prevent permanent sphincter dysfunction and sexual dysfunction. Outcomes are significantly better with early decompression. Persistent radiculopathy without neurological compromise is managed conservatively for 6–12 weeks before elective surgery. MRI findings alone, without clinical neurological deterioration, are not an indication for emergency surgery.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.