A 55-year-old man with chronic low back pain develops severe backache, bilateral sciatica, perianal numbness, and new-onset urinary retention with overflow incontinence over 24 hours. MRI confirms a massive central disc prolapse at L4-L5. What is the correct management?

• A Continue conservative treatment for 6 weeks before reconsidering surgery
• B Emergency MRI-guided epidural steroid injection
• C Traction and bed rest until urinary symptoms resolve
• D Urgent surgical decompression, preferably within 48 hours ✓

Explanation

Saddle anaesthesia plus bladder or bowel dysfunction defines cauda equina syndrome, a surgical emergency caused by compression of the lumbosacral nerve roots below the conus. Delayed decompression risks permanent sphincter and sexual dysfunction, so urgent discectomy within about 48 hours is advised. Conservative care, traction, or injection alone are inappropriate once sphincter involvement has appeared.

Reference: Essential Orthopaedics (Maheshwari), 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.