A 56 year old machine operator presented with mild weakness and sensory disturbance in his lower limbs after he woke up from an arthroscopy operation. At the time he did not seek medical attention. His symptoms progressed over the next four months to the degree that he was unable to stand and he developed back pain radiating to the legs, urinary frequency, hesitancy, and incontinence of urine. There was no history of claudication in the legs. He was a heavy smoker and suffered from ischaemic heart disease and type 2 diabetes mellitus.

On examination he was overweight. Straight leg raising test was within normal limits. Neurological examination showed normal cranial nerves and normal upper limbs. Lower limb examination revealed grade 3/4 proximal limb weakness with absent ankle jerks and equivocal plantar responses. Light touch and pinprick sensation was impaired in L1-S3 distribution bilaterally with impaired vibration. Coordination was normal. The remaining physical . . . [Full text of this article]