A 67-year-old man presented to his general practitioner with intermittent episodes of unilateral sciatica over a 2-month period for which he was referred for an outpatient MRI of his spine. This evidenced a significant lumbar vertebral mass that showed tight canal stenosis and compression of the cauda equina. The patient was sent to the emergency department for management by orthopaedic surgeons. He was mobilising independently, pain free on arrival and without neurological deficit on assessment. Clinically, this patient presented with no red flag symptoms of cauda equina syndrome or reason to suspect malignancy. In these circumstances, National Institute for Health and Care Excellence guidelines do not support radiological investigation of the spine outside of specialist services. However, in this case, investigation helped deliver urgent care for cancer that otherwise may have been delayed. This leads to the question, do the current guidelines meet clinical requirements?
- general practice / family medicine
- prostate cancer
- orthopaedic and trauma surgery
- spinal cord
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RSS and MSC are joint first authors.
Contributors I, RSS, first author contributed to the patient consent, planning, conduct, write up, editing, final review and revision of the case report. MSC contributed to the planning, write up, editing, final review and revision of the case report and would be a joint first author. HA contributed by providing anonymised radiological images with arrows, relevant clinical information from the hospital system and was involved in reviewing the write up and would be third author. MvL contributed by reviewing, editing the write up, providing expertise, advice, final review, revision and supervising the case report and is the corresponding author.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.