How would you approach a patient presenting with suspected radiculopathy due to a lumbar disc herniation who also has progressive neuro deficits?

• A. Wait and see
• B. Immediately schedule surgery without imaging
• C. Treat with antibiotics
• D. Obtain urgent MRI to evaluate compression; consider neurosurgical referral if deficits progress; continue conservative management if stable

Answer: (D)

Progressive neurologic deficits with suspected lumbar disc herniation signal potential ongoing nerve compression that could worsen or become irreversible if not addressed promptly. The key step is to image the spine to confirm whether there is compression, identify the level, and assess the severity. An urgent MRI is the best way to visualize nerve roots, the thecal sac, and the exact nature of the disc pathology, which directly informs whether surgical decompression might be needed and how urgently.

If the deficits are worsening, early neurosurgical referral is appropriate because timely decompression can improve or protect neurologic function. If imaging shows clear compression with progressive signs, moving toward surgical planning is warranted. If, on the other hand, the deficits are stable and imaging does not reveal a pressing compressive process, continuing conservative management—pain control, physical therapy, and close follow-up—remains reasonable, with instructions to seek care if symptoms escalate.

Avoiding imaging or delaying evaluation in this scenario risks missing a surgically treatable compression; antibiotics are not indicated for radiculopathy, and surgery without imaging would lack essential information about the pathology.