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 disc that is compressing the spinal nerve roots.
Case history #2
A 23-year-old 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. After discharge, the patient began to experience 'trouble' passing urine. The next day, the back pain had increased, she could not void, and she had upper leg pain. She attended a second emergency department, where 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 disc herniation at L4-S1.
Other presentations
Almost all patients with CES have sciatica and/or low back pain at presentation. More specific features of CES include: difficulty starting or stopping urination or impaired sensation of urinary flow; urgency; urinary retention with overflow urinary incontinence; loss of sensation of rectal fullness; faecal incontinence; laxity of the anal sphincter; saddle anaesthesia or paraesthesia; progressive neurological deficits affecting both legs; 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.[6][7]
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