16th August 2024

A 59-year-old female is urgently referred by her GP to the Rapid Access Medical Clinic with bilateral leg weakness

A 59-year-old female is urgently referred by her GP to the Rapid Access Medical Clinic with bilateral leg weakness. She is accompanied by family members who help her to walk.

She has a history of breast cancer requiring mastectomy some years ago, followed by the requisite course of tamoxifen. She is otherwise fit and well.

On history taking, she reports that she has recently noticed some fatigue and weight loss, and has been experiencing some troublesome back pain in the last few weeks, which she had attributed to lifting her granddaughter.

Examination reveals preferentially flexor weakness of the lower limbs.

Which is the single most appropriate next investigation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.