Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report
Tianyang Yuan1, Jun Zhang, Lili Yang
1Department of Orthopaedics, The Second Hospital, Jilin University, Changchun, Jilin, China.
Medicine
|July 24, 2019
Summary
Cauda equina syndrome (CES) after lumbar surgery is rare. This case highlights excessive dural sac traction sensitivity as a potential cause, emphasizing gentle surgical technique to prevent this complication.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neurology
Background:
- Cauda equina syndrome (CES) involves compression or damage to the cauda equina nerves, commonly caused by lumbar disc herniation.
- CES as a postoperative complication of lumbar spinal surgery is infrequent, particularly when motor deficits are absent.
Observation:
- A patient with lumbar spinal stenosis underwent decompression and fixation surgery.
- Postoperatively, the patient experienced resolution of pain and neurogenic claudication but developed CES symptoms, including perineal numbness without bladder, anal, or motor dysfunction.
Findings:
- The patient's CES symptoms, characterized by perineal hypoesthesia, resolved spontaneously within six months.
- The proposed cause for postoperative CES in this instance was heightened sensitivity to intraoperative dural sac traction.
Implications:
- This case underscores the rarity of CES post-lumbar surgery and suggests that excessive dural sac traction sensitivity may be an underlying factor.
- Recommendations include avoiding crossing the midline during nerve root retraction and maintaining a parallel plane between the nerve retractor and the dural sac to minimize shear forces and prevent iatrogenic CES.
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