constellation of symptoms similar to prior flares.

Low suspicion for acute cord compression or cauda equina at this time, given presentation and symptoms, including epidural abscess or hematoma. Patient has no history of malignancy, active or distant history.  Patient has no unexplained weight loss. No recent fevers, rigors, malaise, or recent infection.  No history of IVDU or skin-popping.  Patient does not have any history concerning for saddle anesthesia/perianal sensory loss or complaining of decreased rectal tone. Patient does not have urinary retention or inability to control urine from overflow.  Patient has no tenderness overlying spinous process. Patient has no focal weakness on examination.

Given exam and history, low suspicion for cord compression, cauda equina, epidural abscess/hematoma. Distally neurovascuarly intact. Query likely musculoskeletal component versus sciatica. Discussed pain control, physical therapy and follow up with PMD. Cautious return precautions discussed w/ full understanding