A 64-year-old woman presented to the emergency department complaining of severe lower back pain. The pain has started 3 weeks ago, but it became more severe during the last day. She does not report any trauma or previous medical or surgical history. During the past day, the pain did not respond to analgesics. On examination, her blood pressure is 130/85 mm Hg and her pulse is 100/min. Back examination shows that the back pain is exacerbated by back flexion and leg raising. Stroking the skin around the anus does not induce anal contraction. Motor and sensory examination are normal. Which of the following nerve roots is most likely to be involved in this patient's condition?

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Eductional Objective: Lesions compressing the spinal cord at the nerve roots of S4 would lead to loss of anocutaneous reflex and perianal anesthesia. Lumbosacral radiculopathy could be caused by neoplasms, herniating discs, fractures, epidural hematoma, and abscess.

A 64-Year-Old Woman Presented to the Emergency Department Complaining of Severe