Conus Medullaris Syndrome due to Ligamentum Flavum Thickening and Intervertebral Disc Bulging

A 72-year-old male with past medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and depression. He also had chronic low back pain radiating to both legs for over 10-years and was managed with methadone. He presented to the wheelchair clinic in November 2018, because of difficulty in walking due to bilateral leg weakness over 6-months, which had worsened progressively for several weeks. He used a walker initially, but as his symptoms had worsened, together with multiple falls, he presented to request a scooter. On detailed questioning, he reported 2-3 weeks of progressive bladder incontinence; he could not “hold it in” long enough to reach the bathroom. During the same period as the bladder incontinence, he also had constipation, and was unable to achieve an erection. He was recommended to go to the Emergency Department for further evaluation.