Contents
Etiology
- compression of lumbosacral nerve roots below conus medullaris secondary to large central herniated disc (L4-5 or L5-S1) ± spinal stenosis, extrinsic mass
Clinical Features
- motor (LMN signs)
-weakness/paraparesis in multiple root distribution
-reduced deep tendon reflexes (knee and ankle)
-sphincter disturbance (urinary retention and fecal incontinence due to loss of anal sphincter tone) - sensory
-saddle anesthesia (most common sensory deficit)
-pain in back radiating to legs
-bilateral sensory loss or pain: involving multiple dermatomes
-sexual dysfunction (late finding)
Treatment
- surgical emergency – requires urgent investigation and decompression (<48 hrs) to preserve bowel and bladder function