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Summary
Two patients with cauda equina syndrome due to metastatic cancer experienced improved leg strength after surgery. Metastatic spread to the spinal cord occurred via bloodstream and perineural lymphatics.
Area of Science:
- Neurology
- Oncology
- Spinal Surgery
Background:
- Cauda equina syndrome can arise from metastatic disease.
- Metastases from esophageal adenocarcinoma and breast carcinoma are rare causes.
Observation:
- Two cases of cauda equina syndrome are presented.
- Case 1: Medullary cone metastasis from esophageal adenocarcinoma.
- Case 2: Solitary lumbar spinal nerve root metastasis from breast carcinoma.
Findings:
- Postoperative improvement in lower limb muscle strength was observed in both patients.
- Functional recovery of bladder, bowel, and pelvic floor was limited in Case 1.
- Case 2 patient regained useful life despite vertebral osseous involvement.
Implications:
- Hematogenous spread and perineural lymphatic spread are suggested routes for tumor cell dissemination to the spinal cord and subarachnoid space.
- Surgical intervention can offer functional benefits for cauda equina syndrome secondary to spinal metastases.
- Understanding metastatic pathways is crucial for managing spinal cord compression syndromes.