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Orthopaedics · Spine
Sample itemA man with a large lumbar disc prolapse develops bilateral leg weakness, saddle anaesthesia and urinary retention. What is the most appropriate management?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Urgent MRI of the lumbosacral spine and surgical decompression
Saddle anaesthesia, bladder dysfunction and bilateral leg symptoms indicate cauda equina syndrome, a surgical emergency. Urgent MRI confirms compression, and early decompression gives the best chance of recovering bladder, bowel and sexual function. Delay risks permanent deficit.
Option by option
A. Nerve conduction studies in two weeks
Waiting two weeks for electrodiagnostic tests leaves the compression untreated.
B. Urgent MRI of the lumbosacral spine and surgical decompression (correct)
Correct. Rapid imaging and decompression prevent permanent sphincter and motor loss.
C. Bed rest and NSAIDs with outpatient review
Conservative care is inappropriate for a compressive emergency.
D. Epidural steroid injection as an outpatient
An injection does not relieve compression and delays surgery.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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