Case history
Case history #1
A 44-year-old man presents with low back pain that has become worse over the past few days. He reports having difficulty when trying to urinate, and erectile dysfunction of recent onset. Bladder palpation indicates urinary retention. Magnetic resonance imaging (MRI) of the lumbar spine reveals a herniated disk that is compressing the spinal nerve roots.
Case history #2
A 23-year-old white woman presents 24 hours after a fall while ice skating. Initially, she was assisted to stand, and reported back pain and right hip pain. She was examined at a local emergency department, with plain film imaging, and discharged. Prior to discharge the patient reported she had “trouble” passing urine. The next day, the back pain had increased, she could not void, and had upper leg pain. She sought another opinion. At presentation in a second emergency department she reported difficulty lifting her legs (grade 3/5 bilaterally), could not void (post void residual volume 450 ml), and had numbness in her groin/perineum. MRI revealed a large disk herniation at L4-S1.
Other presentations
Features of CES include: low back pain; bilateral sciatica; progressive neurologic deficits; difficulty starting or stopping urination or impaired sensation of urinary flow; urgency; urinary retention with overflow urinary incontinence; loss of sensation of rectal fullness; fecal incontinence; laxity of the anal sphincter; saddle anesthesia or paraesthesia; and sexual dysfunction. However, these clinical features have a limited sensitivity for the diagnosis of CES. A patient with CES may have many of these features or just a few, and onset may be insidious or acute.[4][5][6]
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