A 52-year-old lady was admitted to the local emergency management unit by her general practitioner with a 5-week history of lumbar back pain. She had no significant past medical history and, of note, was not diabetic.
Her symptoms began acutely whilst picking up a heavy box. She experienced sudden onset of severe (10/10) lumbar-back pain with radiation into the left leg. Her general practitioner (GP) diagnosed acute posterolateral disc herniation, and she was treated with standard doses of oral analgesia (paracetamol, tramadol, gabapentin) and oral diazepam which gave partial relief from her symptoms. She was not treated with intravenous or spinal injections of any sort. Over the next 4 weeks, her pain was constant but exacerbated by movement. She was unable to return to work and stayed at home where she was self-caring but with severely restricted mobility. Throughout this period neurological examination was normal, except for reduced straight leg raise.
In the week preceding her admission she developed concurrent systemic symptoms; she complained of nausea, vomiting and intermittent fevers. In addition, the severity of her back pain at rest became unbearable and her sciatica progressed to affect both legs.
On admission, she was apyrexial (but her GP had recorded a temperature of 37.7 °C earlier that day), blood pressure was 184/82, heart rate was 95/min (regular), oxygen saturations were 99% (room air) and respiratory rate was 16/min. She complained of 10/10 pain. The lumbar spine was tender, but it was not warm to touch and there were no skin colour changes. Her neurological examination was restricted by pain, but there was no abnormality detected in tone, power or reflexes in the lower limbs. She was unable to tolerate straight leg raise beyond 15 ° bilaterally, and there was reduced sensation in the left L4/L5 distribution. She had normal anal tone and normal perianal sensation. A few hours after hospital admission she developed acute urinary retention and was catheterised.