EM Board-style Case: Suspected Lumbar Compression

Snapshot: EM board-style vignette of a 34‑year‑old after a fall; likely diagnosis, key imaging clue, and the short answer for exam recall.

A 34-year-old man with no prior medical history presents to you after having fallen from a cliff while rappelling 7 hours ago. He underwent a complicated, prolonged extraction from a ravine, and he is complaining of 10/10 lower back pain. You note that the groin area of his pants is wet and he has no rectal tone on examination. The lateral plain radiograph of his lumbar spine is shown below.

Regarding additional emergent studies of the lower back, which of the following choices is true?

• Emergent electromyography differentiates between specific nerve root compression and an upper motor neuron lesion, which affects management.
• MRI or a CT scan should be performed on an emergent basis for cauda equina syndrome.
• No further studies should be performed – the diagnosis is clear.
• Bone scans are only indicated on an emergent basis if there is a history of cancer or advanced age in addition to bone trauma.

This question appears in Med-Challenger Emergency Medicine Review with CME

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