About management of cauda equine syndrome

A 45-year-old man complains of decreased sensation in his buttocks and inability to achieve an erection. On examination he has decreased anal sphincter tone and decreased ankle reflexes bilaterally. the best next step in management?

• 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.