Case report: cauda equina syndrome associated with an interspinous device
Worawat Limthongkul1, Wicharn Yingsakmongkol
1Department of Orthopaedics, King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Bangkok, 10330, Thailand. dr.worawat@gmail.com
Clinical Orthopaedics and Related Research
|August 27, 2011
Summary
Spinal epidural hematoma (SEH) can cause Cauda Equina Syndrome (CES) after surgery, even without typical risk factors. Prompt surgical decompression is crucial for good neurologic recovery in these rare cases.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neurology
Background:
- Postoperative spinal epidural hematoma (SEH) is a known complication, though surgical intervention is rare.
- Cauda Equina Syndrome (CES) can be associated with SEH, necessitating prompt diagnosis and treatment.
- Risk factors for SEH exist, but cases can occur in patients without identified predisposing conditions.
Observation:
- A 41-year-old male developed CES eight hours post-discectomy with interspinous spacer insertion at L3-4 and L4-5.
- MRI revealed a posterior SEH at L3-4 compressing the thecal sac.
- The interspinous spacer completely obstructed the L3-4 laminotomy site, preventing hematoma drainage.
Findings:
- Early recognition and emergency decompression of SEH are vital for preventing further neurological damage.
- Complete neurologic recovery was observed in the patient after emergency decompression and hematoma evacuation.
- The patient's specific anatomy and the device placement contributed to the obstruction and subsequent hematoma.
Implications:
- Surgeons must consider the possibility of acute CES in patients presenting postoperatively, even in the absence of typical SEH risk factors.
- Wider laminotomy, exceeding half the device size, may prevent obstruction and subsequent SEH when using compressible interspinous devices.
- Patient-specific factors and anatomical considerations are critical in preventing such surgical complications.
