question: Q:A 57-year-old woman presents to an outpatient clinic with lower extremity weakness and lower back pain. The patient says that her symptoms began 2 weeks ago when she was working in her garden and have progressively worsened to the extent she currently is unable to walk on her own. She describes the pain as sharp, severe and descending bilaterally from her lower back to her lateral ankles along the posterior surface of her thighs and legs. She also states that she has had several episodes of urinary incontinence for the past couple of days. The patient denies having any similar pain or incontinence in the past. No other significant past medical history. Current medications are alendronate 5 mg orally daily and a daily multivitamin. Her temperature is 37.0℃ (98.6℉), the blood pressure is 110/70 mm Hg, the pulse is 72/min, the respiratory rate is 15/min, and oxygen saturation is 99% on room air. On physical examination, the patient appears to be in significant distress. Strength is ⅗ in her thighs bilaterally and ⅖ in the legs bilaterally left greater than right. Muscle tone is decreased in the lower extremities. The patellar reflex is 1+ bilaterally and plantar reflex is 0+ bilaterally. Fine touch and pain and temperature sensation are decreased in the lower extremities bilaterally, left greater than right. Saddle anesthesia is present. Which of the following is the next, best step in the management of this patient?? 
  {'A': 'Outpatient management with a 3-day course of meloxicam and tolperisone and reassess', 'B': 'Outpatient management with 3 days of strict bed rest and reassess', 'C': 'Outpatient management with a 3-day course of diclofenac and gabapentin and reassess', 'D': 'Recommend non-emergent inpatient spinal manipulation program', 'E': 'Immediate transfer to the emergency department for management'},