Onset of erectile dysfunction is an uncommon but prognostically
poor symptom. It is present on initial presentation
in less than 5% of patients with CES. Still, up to 30%
of patients experience some form of erectile dysfunction on
long-term follow-up, despite timely treatment.32
A thorough neurologic examination helps establish the
spinal level of the lesion and differentiate between complete
and incomplete loss of function. Most patients have
an objective sensory deficit in the lower extremities and
weakness less than or equal to 4/5, and 76% of patients
also have decreased perianal sensation.32 Reflexes may be
decreased, with more than half of patients presenting with
an absent ankle jerk reflex. Increased reflexes and long
tract signs may be present with a lesion above the L1–L2
disc. Rectal evaluation may reveal decreased rectal tone,
which further supports the diagnosis of CES