Segmental anomaly leading to wrong level disc surgery in cauda equina syndrome

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Radiology

Background:

• Lumbosacral transitional vertebrae are documented but often overlooked.
• Wrong-level surgery is a known cause of lumbar spine surgery failure.
• Previous literature has not detailed wrong-level surgery in cauda equina syndrome due to unrecognized transitional vertebrae.

Purpose of the Study:

• To highlight the importance of detecting lumbosacral transitional vertebrae.
• To emphasize the potential for surgical errors in lumbar spine interventions.
• To review a case of cauda equina syndrome misdiagnosed due to vertebral anomalies.

Main Methods:

• Case report of a patient with unrecognized S-1 lumbarization.
• Review of literature, clinical course, and imaging studies.
• Discussion of techniques for identifying transitional vertebral bodies.

Main Results:

• An undetected S-1 lumbarization led to misidentification of the L4-5 space.
• The patient underwent decompression at the wrong level (L5-L6 instead of L4-L5).
• This necessitated a second surgery to correct the error.

Conclusions:

• Undetected congenital anomalies like S-1 lumbarization can lead to significant surgical errors.
• Lumbosacral transitional vertebrae are frequently missed on plain radiographs and MRI.
• Vigilance for transitional vertebrae is essential during lumbar spine imaging and surgical planning, especially for disc disease.