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Question Date: 24/09/2023

Question: A 67-year-old man presents with 2 days of severe lumbar back painassociated with bilateral sciatica, leg weakness, urinary retention, fecalincontinence, and sexual dysfunction. Spine MRI studies show amassive midline disk herniation at L4-L5 with compression of the caudaequina. The patient is taken for urgent surgical decompression. Whichof the following symptoms is most likely to improve from this surgery?

Options:

• Anal sphincter dysfunction
• Leg weakness
• Pain
• Sexual dysfunction

Correct Answer: Pain

Explaination: Acute diskogenic cauda equina syndrome warrants emergent surgical decompression. Pain relief is the most frequent benefit of decompression surgery. Chronic residual symptoms including sphincter and sexual dysfunction are frequent after surgery. Prognostic factors for favorable outcome after surgery include incomplete and slowly progressive presentations.

Reference: Page 152,Tarulli AW. Disorders of the cauda equina. Continuum (Minneap Minn). 2015 Feb21(1 Spinal Cord Disorders)146-58. doi 10.121201.CON.0000461090.09736.45. PMID 25651223.