رجل عمره ٤٢ سنة رفع صندوقاً ثقيلاً، وصار عنده ألم أسفل الظهر ينتشر للساقين. الآن لا يحس بالمنطقة حول الشرج والأعضاء التناسلية، ولم يتبول منذ ١٠ ساعات، وعنده ضعف في الساقين. ما الإجراء؟

A 42-year-old lifted a heavy box and developed low back pain radiating to both legs. He now has numbness around the anus and genitals, has not passed urine for 10 hours and has leg weakness. What is done?

1. Vigorous back exercises from today
2. Clinic review in a month
3. Emergency referral: cauda equina
4. Analgesia and a week of rest at home

Answer: C) Emergency referral: cauda equina. Back pain with saddle anaesthesia, urinary retention and leg weakness is cauda equina syndrome, an emergency needing urgent MRI and surgery to prevent permanent damage.