How do you approach the management of a patient with lumbar spinal metastasis with neurologic symptoms but without evidence of spinal cord compression?

From the brief description included, it appears that the lesion is at the level of the cauda equina, a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels of L1-L5, and contains axons of nerves that give both motor and sensory innervation to the legs, bladder, anus, and perineum. This is usually referred to as cauda equina syndrome resulting from compression and disruption of the function of these nerves. It is considered a medical and radiation oncology emergency.

Experts usually recommend an immediate MRI with Gd enhancement. Despite identifying the nerve compression site in this case, a total spine MRI is still advisable to check for potential lesions above the lumbar spine requiring treatment...