Orthopaedics & MSK — MCQs
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A 67-year-old man presents with a 5-week history of progressively worsening lower back pain. He describes difficulty passing urine for the past week and has noticed numbness in his perineal area. On examination, there is reduced anal tone and bilateral leg weakness with absent ankle reflexes. Bladder scan shows 800ml post-void residual volume. What is the most appropriate immediate management?
A 73-year-old woman undergoes dynamic hip screw fixation for an intertrochanteric femur fracture. Post-operatively, she develops sudden onset dyspnoea, hypoxia (SpO2 88% on room air), confusion, and petechial rash over her chest. Her blood pressure is 95/60 mmHg and heart rate 115 bpm. Blood gas shows PaO2 7.8 kPa. What is the most likely diagnosis?
A 63-year-old woman presents with a 2-month history of severe lower back pain. She has lost 8 kg in weight and reports feeling generally unwell. She has a history of smoking 30 cigarettes per day for 40 years. Examination reveals tenderness over the L3 vertebra. What is the single most important investigation to arrange urgently?
A 50-year-old man presents with a 3-month history of lower back pain and morning stiffness lasting 2 hours that improves with exercise. He reports waking at night due to pain. Examination reveals reduced chest expansion (3 cm) and reduced cervical spine rotation. ESR is 40 mm/hr. What is the most appropriate initial pharmacological management?
A 58-year-old woman with known osteoporosis (T-score -3.2) sustains an undisplaced Garden I intracapsular neck of femur fracture. She is independently mobile and has no significant comorbidities. Intraoperatively, during attempted cannulated screw fixation, the fracture displaces. What is the most appropriate management?
A 66-year-old man undergoes hemiarthroplasty for a displaced intracapsular neck of femur fracture. On day 3 post-operatively, he develops acute shortness of breath, confusion, and a petechial rash over his chest and conjunctiva. His oxygen saturation is 88% on room air. Blood tests show: Hb 95 g/L (previously 115 g/L), platelets 85×10⁹/L (previously 250×10⁹/L). What is the most likely diagnosis?
A 45-year-old woman with a 12-week history of inflammatory back pain has normal plain radiographs of her sacroiliac joints. Her HLA-B27 is positive and inflammatory markers are elevated (CRP 45 mg/L). What is the most appropriate next investigation to establish the diagnosis?
A 77-year-old woman with a displaced intracapsular neck of femur fracture is being counselled for surgery. She is independently mobile with a stick and has mild osteoarthritis of the ipsilateral hip with occasional pain. She has no significant comorbidities. Which surgical option should be offered?
A 54-year-old man presents with a 5-month history of lower back pain that radiates to both buttocks and posterior thighs. The pain is worse when walking and relieved by sitting or leaning forward. He can walk further when pushing a shopping trolley. Neurological examination of the lower limbs is normal when supine. Peripheral pulses are palpable and symmetrical. What is the most likely diagnosis?
A 60-year-old man with metastatic prostate cancer presents with a 3-week history of severe lower back pain that is constant and unrelieved by rest. He has developed urinary retention over the past 24 hours and examination reveals saddle anaesthesia and reduced anal tone. His lower limbs show normal power but reduced sensation in an L5-S2 distribution bilaterally. What is the most appropriate immediate management?
Orthopaedics & MSK UK Medical PG Practice Questions and MCQs
Question 71: A 67-year-old man presents with a 5-week history of progressively worsening lower back pain. He describes difficulty passing urine for the past week and has noticed numbness in his perineal area. On examination, there is reduced anal tone and bilateral leg weakness with absent ankle reflexes. Bladder scan shows 800ml post-void residual volume. What is the most appropriate immediate management?
- A. Urgent MRI spine and neurosurgical referral within 24 hours (Correct Answer)
- B. Start oral dexamethasone and arrange routine MRI within 2 weeks
- C. Prescribe analgesia and physiotherapy referral
- D. Arrange urgent CT lumbar spine and urology review
- E. Insert urinary catheter and discharge with GP follow-up
Explanation: ***Urgent MRI spine and neurosurgical referral within 24 hours*** - The patient exhibits classic signs of **Cauda Equina Syndrome (CES)**, including progressively worsening lower back pain, **saddle anesthesia** (perineal numbness), **urinary retention** (difficulty passing urine, 800ml PVR), **reduced anal tone**, and **bilateral leg weakness with absent ankle reflexes**. - **CES is a neurosurgical emergency** requiring **urgent MRI of the spine** for diagnosis and immediate surgical decompression, ideally within **24-48 hours**, to prevent permanent neurological, bowel, and bladder dysfunction. *Start oral dexamethasone and arrange routine MRI within 2 weeks* - **Dexamethasone** is primarily used for **metastatic spinal cord compression** to reduce peritumoral edema, not directly indicated for the mechanical compression seen in typical CES. - A **routine MRI within 2 weeks** is unacceptable for suspected CES, as delayed diagnosis and intervention lead to a high risk of irreversible **nerve root damage**. *Prescribe analgesia and physiotherapy referral* - While analgesia may provide symptomatic relief, it does not address the critical underlying **spinal cord compression** that requires immediate surgical intervention. - **Physiotherapy** is contraindicated in the acute phase of CES, as mechanical manipulation can potentially worsen nerve damage or delay essential definitive treatment. *Arrange urgent CT lumbar spine and urology review* - **MRI** is the gold standard for diagnosing CES because it provides superior visualization of **soft tissues**, nerve roots, and the extent of compression in the spinal canal compared to **CT**. - While urinary symptoms are present, the primary pathology is neurological compression, making a **neurosurgical review** more appropriate and urgent than a urology review in the acute phase. *Insert urinary catheter and discharge with GP follow-up* - Inserting a **urinary catheter** is a supportive measure for managing urinary retention, but it does not treat the underlying cause of **CES**. - **Discharging the patient** with suspected CES and only GP follow-up is dangerous, as it would lead to a failure to address the surgical emergency and almost certainly result in permanent disability.
Question 72: A 73-year-old woman undergoes dynamic hip screw fixation for an intertrochanteric femur fracture. Post-operatively, she develops sudden onset dyspnoea, hypoxia (SpO2 88% on room air), confusion, and petechial rash over her chest. Her blood pressure is 95/60 mmHg and heart rate 115 bpm. Blood gas shows PaO2 7.8 kPa. What is the most likely diagnosis?
- A. Pulmonary embolism
- B. Fat embolism syndrome (Correct Answer)
- C. Bone cement implantation syndrome
- D. Myocardial infarction
- E. Hospital-acquired pneumonia
Explanation: ***Fat embolism syndrome*** - The classic clinical triad of **respiratory distress** (dyspnoea, hypoxia), **neurological symptoms** (confusion), and a **petechial rash** (over the chest) is highly indicative of fat embolism syndrome. - This syndrome typically occurs **24 to 72 hours** after **long bone fractures** (e.g., intertrochanteric femur fracture) or orthopedic surgery, due to fat globules entering the systemic circulation. *Pulmonary embolism* - While presenting with sudden onset **dyspnoea and hypoxia**, a **petechial rash** and significant **confusion** are not typical features of pulmonary embolism. - It is a common postoperative complication, but the constellation of symptoms in this case points more specifically to FES. *Bone cement implantation syndrome* - This syndrome occurs **intra-operatively** during **cemented orthopedic procedures**, causing acute cardiovascular collapse. - Dynamic hip screw fixation is generally a **non-cemented** procedure, and the patient's symptoms developed **post-operatively**, not intra-operatively. *Myocardial infarction* - An MI typically presents with **ischemic chest pain**, characteristic **ECG changes**, and elevated **cardiac biomarkers** (e.g., troponins). - While it can cause hypotension and dyspnoea, it does not account for the **petechial rash** or the specific neurological presentation. *Hospital-acquired pneumonia* - This infection usually manifests more than **48 hours after hospital admission** with symptoms like fever, productive cough, and **pulmonary infiltrates** on imaging. - The sudden onset of confusion and the distinctive **petechial rash** are not characteristic features of hospital-acquired pneumonia.
Question 73: A 63-year-old woman presents with a 2-month history of severe lower back pain. She has lost 8 kg in weight and reports feeling generally unwell. She has a history of smoking 30 cigarettes per day for 40 years. Examination reveals tenderness over the L3 vertebra. What is the single most important investigation to arrange urgently?
- A. Plain radiographs of lumbar spine
- B. MRI lumbar spine (Correct Answer)
- C. CT chest, abdomen, and pelvis
- D. Bone scan
- E. Serum prostate-specific antigen
Explanation: ***MRI lumbar spine*** - This patient presents with multiple **red flags** for **spinal malignancy**, including severe persistent back pain, unexplained weight loss, age over 50, and a significant smoking history, along with localized vertebral tenderness. - **Urgent MRI** is the most sensitive and specific investigation for suspected **spinal metastasis** or **spinal cord compression**, providing excellent visualization of the spinal cord, nerve roots, vertebral marrow, and surrounding soft tissues. *Plain radiographs of lumbar spine* - **Plain X-rays** are insensitive for detecting early **bone metastases**, as they require a significant amount of bone destruction (typically 30-50%) to be visible. - They do not adequately visualize the **spinal cord** or **soft tissues**, making them insufficient to assess for **spinal cord compression** which is a critical concern. *CT chest, abdomen, and pelvis* - While a **CT scan** of the chest, abdomen, and pelvis is essential for **staging** a potential **primary malignancy** (especially lung cancer in a heavy smoker), it is not the initial urgent investigation for assessing the **spine** itself. - It offers less detail than MRI for evaluating the **spinal cord** and marrow, and typically follows MRI if spinal pathology is confirmed and a primary source is sought. *Bone scan* - A **bone scan** is highly sensitive for detecting areas of increased **osteoblastic activity** (often seen in metastases) but lacks specificity and anatomical detail. - It cannot provide the necessary information about **spinal cord involvement** or the extent of **epidural compression**, which is crucial for immediate management decisions. *Serum prostate-specific antigen* - This investigation is completely **inappropriate** for this patient, as **prostate-specific antigen (PSA)** is a tumor marker exclusively used for screening and monitoring **prostate cancer**, a disease specific to males. - The clinical context points towards malignancies common in women and smokers, such as **lung** or **breast cancer**, not prostate cancer.
Question 74: A 50-year-old man presents with a 3-month history of lower back pain and morning stiffness lasting 2 hours that improves with exercise. He reports waking at night due to pain. Examination reveals reduced chest expansion (3 cm) and reduced cervical spine rotation. ESR is 40 mm/hr. What is the most appropriate initial pharmacological management?
- A. Paracetamol and reassurance
- B. Non-steroidal anti-inflammatory drug (NSAID) at full dose (Correct Answer)
- C. Low-dose oral corticosteroid
- D. Disease-modifying antirheumatic drug (methotrexate)
- E. TNF-alpha inhibitor (adalimumab)
Explanation: ***Non-steroidal anti-inflammatory drug (NSAID) at full dose***- **NSAIDs** are the first-line pharmacological treatment for **ankylosing spondylitis** (AS), providing significant relief for inflammatory back pain and stiffness.- They should be used at the **maximum tolerated dose** for at least 2–4 weeks to evaluate effectiveness before considering alternative treatments.*Paracetamol and reassurance*- **Paracetamol** is generally inadequate as monotherapy for **inflammatory back pain** because it lacks the necessary anti-inflammatory properties found in NSAIDs.- Simply offering reassurance is inappropriate given the clinical evidence of **reduced chest expansion** and **spinal mobility**, which necessitate active management.*Low-dose oral corticosteroid*- **Oral corticosteroids** are not recommended for the routine management of **axial disease** in ankylosing spondylitis due to a lack of evidence for long-term efficacy.- While useful for acute flares of **peripheral arthritis**, they do not prevent the progression of spinal fusion or provide sustained relief in axial spondyloarthritis.*Disease-modifying antirheumatic drug (methotrexate)*- **Conventional synthetic DMARDs** like **methotrexate** or sulfasalazine have no proven benefit in treating the **axial (spinal) symptoms** of AS.- These agents are only considered if there is concurrent **peripheral joint involvement** (e.g., dactylitis or arthritis in the limbs).*TNF-alpha inhibitor (adalimumab)*- **TNF-alpha inhibitors** are highly effective but are reserved for patients who have failed to respond to at least two different **NSAIDs** over a period of 4 weeks.- They are **second-line** biological therapies and involve strict criteria regarding disease activity scores (e.g., BASDAI) before initiation.
Question 75: A 58-year-old woman with known osteoporosis (T-score -3.2) sustains an undisplaced Garden I intracapsular neck of femur fracture. She is independently mobile and has no significant comorbidities. Intraoperatively, during attempted cannulated screw fixation, the fracture displaces. What is the most appropriate management?
- A. Continue with cannulated screw fixation as originally planned
- B. Convert to dynamic hip screw fixation
- C. Convert to cemented hemiarthroplasty (Correct Answer)
- D. Abandon surgery and manage conservatively
- E. Convert to uncemented total hip replacement
Explanation: ***Convert to cemented hemiarthroplasty*** - Once an intracapsular fracture **displaces intraoperatively**, the risk of **avascular necrosis (AVN)** and **non-union** increases significantly, making internal fixation unreliable. - **Cemented hemiarthroplasty** is the standard recommended treatment for displaced intracapsular fractures in elderly patients as it allows for **immediate weight-bearing** and avoids the complications of fixation failure. *Continue with cannulated screw fixation as originally planned* - Internal fixation is only indicated for **undisplaced (Garden I and II)** fractures; proceeding after displacement leads to high rates of **re-operation** and failure. - The **retinacular blood supply** to the femoral head is likely compromised by the displacement, making hardware failure or AVN highly probable. *Convert to dynamic hip screw fixation* - A **Dynamic Hip Screw (DHS)** is primarily indicated for **extracapsular (intertrochanteric)** hip fractures, not for intracapsular fractures. - It does not address the risk of **femoral head osteonecrosis** associated with displaced intracapsular fractures. *Abandon surgery and manage conservatively* - Conservative management is generally inappropriate for a displaced hip fracture as it leads to **prolonged immobility**, increasing the risk of **pneumonia**, **pressure sores**, and **VTE**. - Surgery is essential to restore **mobility** and provide effective **pain relief** in an independently mobile patient. *Convert to uncemented total hip replacement* - While **Total Hip Replacement (THR)** is considered for active patients, **cemented fixation** is usually preferred over uncemented in patients with a **T-score of -3.2** (severe osteoporosis) to prevent periprosthetic fractures. - THR is more commonly reserved for patients with **pre-existing osteoarthritis** or those who are extremely active, whereas hemiarthroplasty is a standard response to intraoperative displacement in this age group.
Question 76: A 66-year-old man undergoes hemiarthroplasty for a displaced intracapsular neck of femur fracture. On day 3 post-operatively, he develops acute shortness of breath, confusion, and a petechial rash over his chest and conjunctiva. His oxygen saturation is 88% on room air. Blood tests show: Hb 95 g/L (previously 115 g/L), platelets 85×10⁹/L (previously 250×10⁹/L). What is the most likely diagnosis?
- A. Hospital-acquired pneumonia
- B. Pulmonary embolism from deep vein thrombosis
- C. Fat embolism syndrome (Correct Answer)
- D. Bone cement implantation syndrome
- E. Transfusion-related acute lung injury
Explanation: ***Fat embolism syndrome*** - The patient presents with the classic clinical triad of **respiratory distress** (acute shortness of breath, O2 sat 88%), **neurological dysfunction** (confusion), and a **petechial rash** (chest and conjunctiva) occurring 24–72 hours after orthopedic surgery (day 3 post-op). - This diagnosis is strongly supported by the associated lab findings of **thrombocytopenia** (platelets 85×10⁹/L) and a drop in **hemoglobin** (Hb 95 g/L), which are consistent with the systemic inflammatory response seen in FES. *Hospital-acquired pneumonia* - While pneumonia can cause shortness of breath and hypoxemia, it typically presents with **fever**, **cough** (often productive), and evidence of **pulmonary infiltrates** on imaging. - It does not explain the presence of a **petechial rash** or the acute drops in **hemoglobin** and **platelets** characteristic of FES. *Pulmonary embolism from deep vein thrombosis* - PE can cause acute shortness of breath and hypoxemia, but it typically presents without a **petechial rash** or the profound **neurological changes** (confusion) seen in this patient. - While PE can cause some hemodynamic instability, **thrombocytopenia** and a significant drop in **hemoglobin** are not direct features of acute pulmonary thromboembolism. *Bone cement implantation syndrome* - BCIS is an acute, often severe, physiological disturbance that occurs *intra-operatively* or immediately *post-operatively* (within minutes to hours) during or after the **cementing of prostheses**. - The patient's symptoms developing on **day 3 post-operatively** make BCIS an unlikely diagnosis, as its onset is much earlier. *Transfusion-related acute lung injury* - TRALI is an acute respiratory distress syndrome that develops within **6 hours** of receiving a **blood product transfusion**. - There is no mention of a recent blood transfusion in the patient's history, and the symptoms, particularly the **petechial rash** and the timing, are not consistent with TRALI.
Question 77: A 45-year-old woman with a 12-week history of inflammatory back pain has normal plain radiographs of her sacroiliac joints. Her HLA-B27 is positive and inflammatory markers are elevated (CRP 45 mg/L). What is the most appropriate next investigation to establish the diagnosis?
- A. Repeat plain radiographs in 3 months
- B. CT scan of sacroiliac joints
- C. MRI of sacroiliac joints with STIR sequences (Correct Answer)
- D. Bone scintigraphy
- E. Dual-energy X-ray absorptiometry (DEXA) scan
Explanation: ***MRI of sacroiliac joints with STIR sequences***- **MRI** is the gold standard for diagnosing **non-radiographic axial spondyloarthritis** as it can detect **bone marrow edema** and active inflammation long before changes appear on X-ray.- **STIR (Short Tau Inversion Recovery)** sequences are specifically used to highlight **edema**, which is a hallmark of active sacroiliitis according to the **ASAS criteria**.*Repeat plain radiographs in 3 months*- **Structural changes** such as erosions, sclerosis, or ankylosis visible on plain films can take **years** to develop; a 3-month window is insufficient to detect progress.- Relying on radiographs alone delays diagnosis and initiation of treatment in patients with **early inflammatory disease**.*CT scan of sacroiliac joints*- While **CT** is superior to X-rays for viewing **bone erosions** and structural damage, it cannot detect **active inflammation** or bone marrow edema.- It involves a high dose of **ionizing radiation** to the pelvis, making it less favorable than MRI for initial diagnostic screening.*Bone scintigraphy*- **Bone scans** are highly sensitive for detecting increased bone turnover but are **non-specific**, as uptake can occur due to infection, trauma, or degenerative disease.- It lacks the anatomical resolution and specificity required to confirm a diagnosis of **sacroiliitis** in the context of spondyloarthropathy.*Dual-energy X-ray absorptiometry (DEXA) scan*- **DEXA scans** are utilized to measure **bone mineral density** and diagnose osteoporosis, not to identify inflammatory or structural joint disease.- Although patients with axial spondyloarthritis are at higher risk for **osteoporosis**, this scan does not establish the primary diagnosis of the inflammatory condition.
Question 78: A 77-year-old woman with a displaced intracapsular neck of femur fracture is being counselled for surgery. She is independently mobile with a stick and has mild osteoarthritis of the ipsilateral hip with occasional pain. She has no significant comorbidities. Which surgical option should be offered?
- A. Cemented hemiarthroplasty
- B. Uncemented hemiarthroplasty
- C. Cemented total hip replacement (Correct Answer)
- D. Uncemented total hip replacement
- E. Cannulated screw fixation
Explanation: ***Cemented total hip replacement*** - According to **NICE guidelines**, patients with **displaced intracapsular fractures** who were previously mobile (at least outdoors with a stick) and have **symptomatic osteoarthritis** should receive a **total hip replacement (THR)**. - A **cemented** approach is preferred in older patients to provide immediate stability, facilitate early weight-bearing, and minimize the risk of periprosthetic fractures.*Cemented hemiarthroplasty* - This is generally indicated for patients who are less mobile or have significant cognitive impairment, rather than those with high functional status. - It is unsuitable here because the patient has **ipsilateral hip arthritis**, which would likely cause persistent post-operative pain if the acetabulum is not replaced.*Uncemented hemiarthroplasty* - **Uncemented** prostheses are associated with higher rates of intra-operative and post-operative **periprosthetic fractures** in elderly, osteoporotic bone. - Like cemented hemiarthroplasty, it fails to address the patient's existing **osteoarthritis**, leading to poorer long-term functional outcomes.*Uncemented total hip replacement* - While THR is the correct procedure, the **uncemented** technique is less favorable than cemented in this demographic due to inferior fixation in aged bone. - Evidence suggests that **cemented fixation** offers better long-term implant survival and lower rates of revision in patients over 65.*Cannulated screw fixation* - This internal fixation method is typically reserved for **undisplaced** intracapsular fractures or very young patients. - In an elderly patient with a **displaced fracture**, this option carries an unacceptable risk of **avascular necrosis** and non-union.
Question 79: A 54-year-old man presents with a 5-month history of lower back pain that radiates to both buttocks and posterior thighs. The pain is worse when walking and relieved by sitting or leaning forward. He can walk further when pushing a shopping trolley. Neurological examination of the lower limbs is normal when supine. Peripheral pulses are palpable and symmetrical. What is the most likely diagnosis?
- A. Peripheral arterial disease with intermittent claudication
- B. Lumbar spinal stenosis (Correct Answer)
- C. Bilateral L5-S1 disc herniation
- D. Abdominal aortic aneurysm
- E. Degenerative spondylolisthesis
Explanation: ***Lumbar spinal stenosis*** - The patient exhibits classic **neurogenic claudication**, characterized by lower back pain radiating to the buttocks and thighs, worsened by walking and relieved by **spinal flexion** (sitting or leaning forward). - The **'shopping trolley sign'**, where leaning forward allows walking further, is a hallmark as it increases the cross-sectional area of the **lumbar spinal canal**, relieving pressure on neural elements. *Peripheral arterial disease with intermittent claudication* - **Vascular claudication** from PAD is typically relieved by simply standing still and is not influenced by spinal posture or leaning forward. - The presence of **palpable and symmetrical peripheral pulses** makes significant peripheral arterial disease highly unlikely as the cause of these symptoms. *Bilateral L5-S1 disc herniation* - Disc herniation usually presents with **acute radicular pain**, often exacerbated by sitting, coughing, or a **positive Straight Leg Raise test**, rather than the relief seen with leaning forward. - It rarely presents with the specific type of **postural neurogenic claudication** described, which is characteristic of spinal stenosis. *Abdominal aortic aneurysm* - While a large or leaking **AAA** can cause referred back pain, it does not typically present with the **postural-dependent claudication** symptoms triggered by walking and relieved by leaning. - A physical examination for AAA would likely reveal a **pulsatile abdominal mass**, which is not indicated, and the relief with spinal flexion is not a feature. *Degenerative spondylolisthesis* - Although it can contribute to **spinal stenosis**, isolated **spondylolisthesis** typically causes localized back pain that worsens with lumbar extension and improves with rest. - The specific clinical presentation of **neurogenic claudication** with the characteristic positional relief is best described as **lumbar spinal stenosis**, even if spondylolisthesis is an underlying anatomical cause.
Question 80: A 60-year-old man with metastatic prostate cancer presents with a 3-week history of severe lower back pain that is constant and unrelieved by rest. He has developed urinary retention over the past 24 hours and examination reveals saddle anaesthesia and reduced anal tone. His lower limbs show normal power but reduced sensation in an L5-S2 distribution bilaterally. What is the most appropriate immediate management?
- A. Urgent MRI whole spine within 24 hours
- B. Immediate MRI whole spine and neurosurgical referral (Correct Answer)
- C. Plain radiographs of lumbar spine and referral to oncology
- D. CT lumbar spine and admission for pain management
- E. Catheterisation and routine MRI within 1 week
Explanation: ***Immediate MRI whole spine and neurosurgical referral*** - The patient presents with classic features of **cauda equina syndrome (CES)** secondary to **metastatic spinal cord compression (MSCC)**, evidenced by **saddle anaesthesia**, **urinary retention**, and reduced anal tone. - This is a **neurosurgical emergency**; immediate whole-spine imaging and specialist referral are required to facilitate **surgical decompression** or radiotherapy and prevent permanent neurological loss. *Urgent MRI whole spine within 24 hours* - While NICE guidelines mention 24 hours for stable patients with MSCC, the presence of **acute neurological deficits** (CES) demands **immediate** action rather than a delay. - Waiting 24 hours in the setting of **urinary retention** significantly increases the risk of irreversible **bladder and bowel dysfunction**. *Plain radiographs of lumbar spine and referral to oncology* - **Plain radiographs** lack the sensitivity to detect soft tissue masses or early **thecal sac compression** and are not indicated for diagnosis. - Delayed referral to oncology alone is inappropriate as it bypasses the urgent need for **decompressive surgery** or stabilization by neurosurgery. *CT lumbar spine and admission for pain management* - **CT scans** are less sensitive than **MRI** for evaluating the spinal cord and nerve roots and may miss critical levels of compression. - **Pain management** is supportive, but focusing on it without definitive surgical intervention for **nerve root compression** results in poor long-term outcomes. *Catheterisation and routine MRI within 1 week* - Catheterization treats the symptom of **urinary retention** but does not address the underlying **spinal compression** causing it. - A **routine MRI** timeline (1 week) is dangerous and negligent in the presence of "red flag" neurological symptoms like **reduced anal tone** and **saddle anaesthesia**.
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