Recurrent adjacent segment disease and cauda equina syndrome
Xavier Conesa1, Ferran Pellisé, Susana Núñez
1Unitat d'estudi de la Patologia del Raquis, Hospital Universitari Vall d'Hebron, Pg/Vall d'Hebron 119-129, 08035 Barcelona, Spain. xaviconesa@hotmail.com
Summary
Adjacent segment degeneration (ASD) can cause severe cauda equina compression after lumbar fusion. This case highlights the risk in patients with narrow spinal canals, even when ASD
Area of Science:
- Neurosurgery
- Spinal Surgery
- Radiology
Background:
- Adjacent segment degeneration (ASD) is a potential complication following lumbar fusion surgery.
- While often considered to have low clinical relevance, ASD can lead to significant neurological deficits.
- Recurrent degeneration can occur biomechanically or as part of natural aging.
Observation:
- A 72-year-old male with a history of multiple lumbar fusion-decompression surgeries presented with recurrent symptoms.
- Symptoms included low back pain, radiating leg pain, saddle sensory disturbances, and incontinence, 8 years post-L2-L4 fusion.
- Imaging revealed severe L1-L2 spinal canal stenosis, causing cauda equina compression.
Findings:
- CT myelography confirmed severe spinal stenosis at L1-L2, compressing the cauda equina.
- Electromyography indicated neural compression affecting nerve roots from L3 to S2.
- Surgical decompression and fusion at L1-L2 successfully resolved the patient's symptoms, including incontinence.
Implications:
- Patients with a constitutionally narrow spinal canal undergoing lumbar fusion are at increased risk for severe adjacent segment neurological compression.
- This case underscores the importance of considering ASD as a cause of neurological compromise, even if its reported clinical relevance is low.
- Prompt diagnosis and surgical intervention for symptomatic ASD can lead to significant recovery of neurological function.
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