Saddle anaesthesia (around anus, scrotum or vagina) Distal anaesthesia Evidence of UMN or LMN lesion
Loss of sphincter control or urinary retention Weakness of legs peripherally
Spinal cord (UMN) or cauda equina (LMN) compression
Large disc protrusion, paralysing nerve root
Anaesthesia or paraesthesia of the leg Foot drop Motor weakness Absence of reflexes
Distal pain with or without paraesthesia Radicular pain (sciatica) Positive dural stretch tests
Lumbar pain (unilateral, central or bilateral) ± buttock and posterior thigh pain
Posterolateral disc protrusion on nerve root or disc disruption
Fortunately, syndromes A and B are extremely rare but, if encountered, urgent referral to a surgeon is mandatory. Clinical features of the cauda equina syndrome are presented in Figure 33.8 . Syndrome B can follow a bleed in patients taking anticoagulant therapy or be caused by a disc sequestration after inappropriate spinal manipulation.
Fig. 33.8 Cauda equina syndrome due to massive prolapsed intervertebral disc
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