Jack is a 33 year old who came to the emergency room with severe bilateral leg pain, numbness in his saddle area, and difficultly urinating. He has had back pain for about 2 years, but these symptoms began just a few days ago and have been getting progressively worse.
On exam, Jack couldn’t push his left foot down. We also found that his bladder wasn’t emptying completely.
The MRI showed a bulge in his L5-S1 disc with a superimposed large disc herniation that completely filled the spinal canal. The nerve roots collectively in the low back are called the cauda equina and all of them at L5-S1 were affected.
Jack was taken urgently to surgery. We removed the herniated disc and alleviated the pressure. His symptoms were fortunately much improved after surgery and he left the hospital the next morning.
Disclaimer: Although this is a real patient, I have used a different name for privacy protection and added a few details for educational purposes. This patient gave consent to have his case shared.