A Rare Case of Partial Cauda Equina Syndrome Following Decompression for Spinal Stenosis: An Illustrative Case

Abstract

Cauda equina syndrome (CES) is a rare and critical complication of lumbar disc herniation with a reported incidence between 0.08 and 0.5%. Whether CES occurs because of compression from disc herniation or as a complication of surgery, surgical decompression remains the mainstay of management of CES. In cases of partial CES, without motor symptoms, conservative management may also be considered.

We describe a rare case of partial CES following surgical decompression of spinal stenosis in a patient with adjacent segment disease (ASD) in which no postoperative radiological evidence of residual compression or iatrogenic damage at the associated levels could be found. Given the lack of evidence for further decompression, the patient was successfully managed conservatively and returned to baseline on postoperative day 7.

CES following surgical decompression for lumbar stenosis is a rare but critical complication that results from either primary mechanical compression of the nerve roots or ischemia of the nerve roots secondary to venous congestion. Management of CES depends heavily on the presence of visible compression on imaging studies. The presence of ASD in this case may have resulted in a pro-inflammatory cascade that could have contributed to the development of CES.

Resumo

A síndrome da cauda equina (SCE) é uma complicação rara e crítica da hérnia de disco lombar com uma incidência relatada entre 0,08 e 0,5%. Quer a SCE ocorra devido à compressão da hérnia de disco ou como uma complicação da cirurgia, a descompressão cirúrgica continua sendo o esteio do tratamento da SCE. Em casos de SCE parcial, sem sintomas motores, o tratamento conservador também pode ser considerado.

Descrevemos um caso raro de SCE parcial após descompressão cirúrgica de estenose espinhal em um paciente com doença do segmento adjacente (CIA) no qual nenhuma evidência radiológica pós-operatória de compressão residual ou dano iatrogênico nos níveis associados pôde ser encontrada. Dada a falta de evidências para descompressão adicional, o paciente foi tratado com sucesso de forma conservadora e retornou à linha de base no 7° dia pós-operatório.

A SCE após descompressão cirúrgica para estenose lombar é uma complicação rara, mas crítica, que resulta da compressão mecânica primária das raízes nervosas ou isquemia das raízes nervosas secundária à congestão venosa. O tratamento da SCE depende muito da presença de compressão visível em estudos de imagem. A presença de ASD neste caso pode ter resultado em uma cascata pró-inflamatória que pode ter contribuído para o desenvolvimento de SCE.

Keywords

cauda equina syndrome - adjacent segment disease - spinal stenosis - decompressive - spine surgery

Palavras-chave

síndrome da cauda equina - doença do segmento adjacente - estenose espinhal - descompressiva - cirurgia da coluna

Publikationsverlauf

Eingereicht: 23. Oktober 2023

Angenommen: 21. Oktober 2024

Artikel online veröffentlicht:
27. März 2025

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