26th August 2020

You are a GP trainee. An 82-year-old man, Bill, comes to see you with back pain

You are a GP trainee. An 82-year-old man, Bill, comes to see you with back pain. He tells you it has been going on for months but recently he feels it is getting worse and he has started to notice some weakness in his left leg. It is stopping him from walking to the shops for his daily newspaper. He also mentions that he hasn’t had full control of his bladder for the last week having had several ‘accidents’ where he was not able to get to the toilet in time – but has had normal bladder control in-between.

He has a past medical history of osteoarthritis, stroke, benign prostatic hyperplasia, and hypothyroidism which is treated with levothyroxine 50 mcg daily. You examine him and note that there is mild proximal muscle wasting bilaterally. He is able to stand up from his chair with help from his walking stick. His neurological exam shows a mild weakness (4/5) in hip flexion on both sides. Sensation is intact and reflexes are normal. There is no saddle anaesthesia.

Which of the diagnoses above is responsible for the presentations described?

Select the SINGLE most appropriate option from the list above.