1/10. Lumbar herniated disc presenting with cauda equina syndrome. Long-term follow-up of four cases.BACKGROUND: cauda equina syndrome is a relatively rare presenting symptom of lumbar herniated discs. Early operative decompression is advocated, but it may not always restore the bladder function. In such cases, knowing the long-term outcome of bladder or sphincter disturbances is quite useful in planning the management of these patients. methods: hospital records of patients operated on for lumbar herniated discs were reviewed. charts and imaging studies of those patients who presented with classic cauda equina syndrome were analyzed. RESULTS: There were 4 patients (2.8%) of 144 consecutive surgical series of lumbar disc herniation, whose presenting symptom was classic cauda equina syndrome. Postoperatively, the patients had been followed at the clinic for a mean period of 6.4 years. Certain characteristic findings were noted on patients' neurological and radiological examinations. Although the recovery process of bladder function was very slow, taking months to years, all four patients achieved almost normal voiding with no major impairment of daily activities. CONCLUSIONS: Even if short-term recovery of bladder function is poor after lumbar disc surgery for cauda equina syndrome, the long-term outcome is not necessarily so. We should follow up on these patients with such measures as intermittent self-catheterization and drug therapy, expecting slow but steady recovery of bladder and sphincter function.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/10. Transdural cauda equina incarceration after microsurgical lumbar discectomy: case report.OBJECTIVE AND IMPORTANCE: Complications usually occur when they are least expected. We present an unusual case of nerve entrapment after microsurgical discectomy. CLINICAL PRESENTATION: A patient undergoing uneventful first lumbar microsurgical discectomy developed severe back and leg pain and a progressive neurological deficit during the first postoperative night. Herniation of cauda equina nerve roots had occurred through an unnoticed minimal defect in the dura, which had not caused cerebrospinal fluid leakage. The roots were incarcerated and swollen, and they filled the space of the resected nucleus pulposus. It was presumed that elevation of intra-abdominal pressure and consequent increased intraspinal pressure during extubation led to the herniation of arachnoid and cauda equina roots. The nerve roots were then trapped and incarcerated in the manner of bowel loops in an abdominal wall hernia. INTERVENTION: During reoperation, the nerve roots were repositioned into the dural sac. The patient recovered without further complications and without long-term sequelae. CONCLUSION: All dural tears that occur during intraspinal surgery, even if they are small and the arachnoid is intact, should be closed with stitches or at a minimum with a patch of muscle or gelatin sponge with fibrin glue. Care should be taken to avoid increased intra-abdominal pressure during extubation. Excessive pain and progressive neurological dysfunction occurring shortly after microsurgical lumbar discectomy or any intraspinal procedure is indicative of possible hemorrhage with subsequent compression of nerve roots. The case reported here provides anecdotal evidence that this situation can also be caused by a herniation of cauda equina nerve roots through a small dural defect that was not evident during the initial operation.- - - - - - - - - - ranking = 2keywords = herniation (Clic here for more details about this article) |
3/10. Surgery for lumbar disc herniation during pregnancy.STUDY DESIGN: The case reports of three pregnant patients with lumbar disc herniation causing cauda equina syndrome or severe neurologic deficits are presented to illustrate that disc surgery during gestation is a safe method of management. OBJECTIVE: To emphasize the importance of recognizing and definitively treating lumbar disc displacement causing neurologic deficits during pregnancy. SUMMARY OF BACKGROUND DATA: The advent of magnetic resonance imaging and modern surgical techniques for treatment of lumbar disc displacement allows safe management of this condition at any stage of gestation. A review of the literature on the risks of nonobstetric surgery and the risks of delaying disc surgery until delivery shows that operating at any stage during gestation for severe neurologic deficit secondary to lumbar disc displacement is justified. methods: A review of the literature on the use of magnetic resonance imaging scan and nonobstetric surgery during pregnancy was performed. Three case reports of the authors' patients who had lumbar disc displacement with cauda equina syndrome or severe neurologic deficit are presented. patients were placed prone on a four-poster frame, and an epidural anesthetic agent was administered. A one-level hemilaminectomy, partial facetectomy, and disc excision were performed in all three cases. RESULTS: The methods used for diagnosis and surgical treatment of three patients with disc herniation during pregnancy resulted in a satisfactory outcome for both mother and child. The medical literature supports surgical intervention in pregnant patients with cauda equina syndrome and severe and/or progressive neurologic deficit(s) from lumbar disc displacement at any state of gestation. CONCLUSION: Although extremely rare, cauda equina syndrome and severe and/or progressive neurologic deficit caused by lumbar disc displacement can occur during pregnancy. The prevalence of symptomatic lumbar disc herniation during pregnancy may be on the increase because of the increasing age of patients who are becoming pregnant. These cases showed, and the literature confirms, that pregnancy at any stage is no contraindication to magnetic resonance imaging scan, epidural and/or general anesthesia, and surgical disc excision.- - - - - - - - - - ranking = 7keywords = herniation (Clic here for more details about this article) |
4/10. Lumbar disc herniation and cauda equina syndrome. Considerations on a pathology with different clinical manifestations.The authors describe six cases of cauda equina syndrome (CES) with different clinical manifestations, etiopathogenetic causes, and degrees of disc prolapse. In three of the cases, the clinical onset was dramatic and acute, in the others it was a hemisyndrome (with acute onset in only 1 case). The site of the disc prolapse was L4-L5 in 3 patients, L3-L4 in 2 patients, and L5-S1 in 1 patient. The authors emphasize the need for the early recognition of the syndrome with a careful clinical examination and history of the patient, as well as timely treatment within 24 hours. For the sake of prevention, and particularly when the hernia is large, the authors suggest monitoring of the stability of the residual disc during surgery and postoperatively the use of a brace for at least one month.- - - - - - - - - - ranking = 4keywords = herniation (Clic here for more details about this article) |
5/10. cauda equina compression syndrome in a child due to lumbar disc herniation.INTRODUCTION: cauda equina syndrome with sphincter dysfunction is an uncommon and feared complication of lumbar disc herniation. CASE REPORT: Lumbar disc disease in the pediatric age has been reported infrequently, but to the best of our knowledge, this is the first pediatric case of acute lumber disc herniation presenting with caudal compression.- - - - - - - - - - ranking = 6keywords = herniation (Clic here for more details about this article) |
6/10. A case with cauda equina syndrome due to bacterial meningitis of anterior sacral meningocele.STUDY DESIGN: A case of a patient with anterior sacral meningocele that was misdiagnosed as perianal abscess is presented. After the transrectal aspiration, the patient developed meningitis and cauda equina syndrome. OBJECTIVE: To report a rare case of anterior sacral meningocele in which primary presentation was mimicking perianal abscess. SUMMARY AND BACKGROUND DATA: Anterior sacral meningocele is a rare example of spinal dysraphism. It is created by a herniation of a dural sac through a defect in the sacral wall. It is usually asymptomatic until later decades. Most of the presenting symptoms are related to the pelvic organs. In the management of anterior sacral meningocele, surgical treatment is necessary. methods: The reported case is that of a 35-year-old female with cauda equina syndrome due to bacterial meningitis of the anterior sacral meningocele. At the beginning, she presented signs and symptoms resembling perianal abscess. She was misdiagnosed as anorectal abscess according to the computed tomography findings. The patient then underwent transrectal aspiration. Following the aspiration, meningitis and cauda equina syndrome were developed. meningitis was treated with the appropriate antibiotics, and the patient underwent rehabilitation for paraplegia and bladder and bowel incontinence. RESULTS: Following the rehabilitation program, the patient has recovered completely within 8 months. CONCLUSION: This case represents a rare example of anterior sacral meningocele in which the patient was misdiagnosed as perianal abscess. meningitis either iatrogenic or spontaneous may occur during the course of anterior sacral meningocele. Once it has occurred, it may result in severe morbidity and mortality. However, our case had been treated effectively, and she had regained her health with rehabilitation program.- - - - - - - - - - ranking = 3.6217897176071keywords = herniation, meningocele (Clic here for more details about this article) |
7/10. Intradural disc herniation and epidural gas: something more than a casual association?STUDY DESIGN: The case of a patient with an intradural disc herniation associated with gas in the spinal canal is presented. OBJECTIVE: To alert spine surgeons to this potential association. SUMMARY OF BACKGROUND DATA: This association was described previously in five patients, a fact that seems surprising given the relative rarity of both intraspinal gas and intradural herniations. methods: The case is presented of a female patient with lumbosciatic pain who developed an incomplete cauda equina syndrome. An asymmetric discopathy of the L2-L3 space and a gas bubble with disc material within the spinal canal was noticed in the radiologic explorations. The literature and the authors' experience are reviewed with the aim of confirming the frequency of intradural herniation in association with gas in the spinal canal. RESULTS: A laminoarthrectomy of the involved space was performed followed by direct intradural examination, which revealed a disc fragment that was excised. An instrumented L2-L3 arthrodesis was performed. Postoperative evolution was satisfactory. To date, the authors have found this association in 2% of the patients with intraspinal gas. CONCLUSION: The potential presence of an intradural disc herniation must always be considered when performing an open discectomy on a patient whose CT scan study shows the presence of epidural gas. This association is particularly striking given the relative rarity of intradural herniations and intraspinal gas. In the event that no clear disc herniation was found, an intradural examination may be indicated to justify clinical signs and symptoms or previous radiologic studies.- - - - - - - - - - ranking = 10keywords = herniation (Clic here for more details about this article) |
8/10. chiropractic high-velocity low-amplitude spinal manipulation in the treatment of a case of postsurgical chronic cauda equina syndrome.OBJECTIVE: To present an evidence-based case report on the use of chiropractic high-velocity low-amplitude spinal manipulation in the treatment a postsurgical, chronic cauda equina syndrome patient. CLINICAL FEATURES: A 35-year-old woman presented with complaints of midback pain, low-back pain, buttock pain, saddle anesthesia, and bladder and bowel incontinence, all of 6 months duration. The patient was 6 months post emergency surgery for acute cauda equina syndrome due to lumbar disc herniation. She had been released from neurosurgical care with the current symptoms considered to be residual and nonprogressive. INTERVENTION AND OUTCOME: The patient was treated with high-velocity low-amplitude spinal manipulation and ancillary myofascial release. After 4 treatments, the patient reported full resolution of midback, low back, and buttock pain. The patient was seen another 4 times with no improvement in her neurologic symptoms. No adverse effects were noted. CONCLUSION: This appears to be the first published case of chiropractic high-velocity low-amplitude spinal manipulation being used for a patient with chronic cauda equina syndrome. It seems that this type of spinal manipulation was safe and effective for reducing back pain and had no effect on neurologic deficits in this case.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
9/10. Spinal nerve root ganglionitis as a cause of disc herniation: case report.The authors report on a patient in whom monoradicular pain was caused by ganglionitis of a spinal nerve. neuroimaging and intraoperative findings identified what were thought to be tumorlike changes in the affected nerve root. The neuropathological examination, however, revealed typical signs of ganglionitis. This rare inflammation usually appears with viral infections, as part of paraneoplastic symptoms, or in the presence of Sjogren disease. Because all of these differential diagnoses were negative in the treated patient, chronic nerve root compression due to disc herniation was suspected as the causative factor for the spinal ganglionitis.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
10/10. Herniated intervertebral disc associated with a lumbar spine dislocation as a cause of cauda equina syndrome: a case report.To report a case of cauda equina syndrome with the completion of the paralysis after the reduction of a L4L5 dislocation due to a herniated disc. Although several articles have described a post-traumatic disc herniation in the cervical spinal canal, this is not well known in the lumbar region. A 30-year-old man was admitted to the emergency room with blunt trauma to the chest and abdomen with multiple contusions plus a dislocation of L4-L5 with an incomplete neurological injury. After an emergency open reduction and instrumentation of the dislocation, the patient developed a complete cauda equina syndrome that has resulted from an additional compression of the dural sac by a herniated disc. In a dislocation of the lumbar spine, MRI study is mandatory to check the state of the spinal canal prior to surgical reduction. A posterior approach is sufficient for reduction of the vertebral displacement, however an intra-canal exploration for bony or disc material should be systematically done.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
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