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Synovial cysts and the lithotomy position causing cauda equina syndrome
John H Wills1, Saul Wiesel, Stephen E Abram
1Department of Anesthesiology and CCM, MSC 11-6120, 1 University of New Mexico, Albuquerque, NM 87131, USA. jwills@salud.unm.edu
Regional Anesthesia and Pain Medicine
|May 13, 2004
Summary
This case report details how the lithotomy position, combined with existing spinal stenosis and synovial cysts, can cause cauda equina syndrome. This positioning led to ischemic compression injury of the cauda equina.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Medicine
Background:
- Cauda equina syndrome (CES) is a rare but serious condition affecting the nerve roots at the end of the spinal cord.
- The lithotomy position is commonly used for procedures like transurethral prostate resection but can alter spinal canal dimensions.
Observation:
- A patient undergoing prostate surgery in the lithotomy position developed CES.
- Facet joint synovial cysts were identified as a contributing factor.
- The patient had a pre-existing critically stenosed lumbar spinal canal.
Findings:
- The lithotomy position, in conjunction with a stenosed spinal canal and synovial cysts, critically narrowed the spinal canal's cross-sectional area.
- This mechanical compression resulted in ischemic injury to the cauda equina.
- Other potential causes of CES, including hematoma, abscess, needle trauma, and neurotoxicity, were ruled out.
Implications:
- This case highlights a novel mechanism for iatrogenic cauda equina syndrome.
- Awareness of spinal canal dimensions and patient positioning is crucial in preventing neurological injury.
- Consideration of pre-existing spinal stenosis and synovial cysts is important in patients undergoing procedures in the lithotomy position.