Cauda equina

BACKGROUND: Cauda equina syndrome (CES) is a consequence of a variety of etiologies. CES is most commonly due to compression of the thecal sac and nerve roots by a massive disc herniation. However, it rarely presents secondary to aortic occlusion. Aortoiliac occlusive disorder is usually associated with chronic claudication, erectile dysfunction, and diminished lower limb pulses. Acute aortic occlusion, however, is associated with serious complications such as spinal cord infarction and ischemia...

Intradural Extraosseous Ewing sarcoma (IEES) is an infrequent occurrence. We report a case of a 66-year-old male who presented with a 2-month history of low back pain and bilateral S1 sciatica, with acute sphincter dysfunction. Imaging studies revealed an intradural extramedullary lesion in the cauda equina spanning from level L4 to S1. The patient underwent partial removal of the intradural lesion. Histopathological examination showed the presence of small round cells, which were consistent with Ewing Sarcoma...

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Synovial spinal cysts cause radiculopathy and back pain, with rare reports of cauda equina syndrome. Hypermobility and instability are cornerstones for synovial cyst formation. The incidence is around 5%, and data for bilateral cysts are lacking. Surgery is indicated after conservative measures fail. Recurrence is common and is potentially due to joint violation and destabilization from open surgery. This could be prevented via ultra-minimally invasive approaches. The authors present full endoscopic removal of bilateral synovial cysts in a patient with grade 1 stable spondylolisthesis and include a 360° view for confirmation of complete decompression...

<p>Peripheral nerve injuries after being struck by lightning have been documented. Here, we report a case of cauda equina syndrome induced by lightning. A 27-year-old man presented with numbness, a burning sensation in the saddle region, and increased urinary urgency after being struck by lightning. He had absent Achilles reflexes and paresthesia in the saddle region upon neurological examination, and magnetic resonance imaging of the spine was normal. Electrophysiological studies indicated involvement of bilateral L5, S1, and S2 myotomes and revealed cauda equina lesions...

INTRODUCTION: Pneumorrachis is presence of air in the epidural space. It could be the result of trauma, barotrauma, iatrogenic or spontaneous. The pneumorrachis per se is an underdiagnosed entity as most of the patients are asymptomatic or have subclinical symptoms. The spontaneous occurrence of pneumorrachis has been reported in literature but giant spontaneous occurrence causing cauda equina syndrome has not been reported so far. CASE PRESENTATION: We report a case of 56-year-old male patient who came to our OPD on wheelchair with complains of difficulty in walking for 6 months with dribbling of urine for 2 months with on and off back pain...

BACKGROUND: Intradural spinal tumors are an uncommon entity with a variety of pathologies and symptom patterns. Few cases reports in the literature have described tumor migration within the spinal canal. OBSERVATIONS: A 38-year-old male presented with bilateral upper lumbar radicular symptoms of anterior thigh pain, with an enhancing tumor of the cauda equina initially located at L1-2. He declined surgery initially, and at a follow-up 3 years later, his symptoms were unchanged but the tumor was now located at T12-L1...

Relatively more-apparent body parts are often used to name relatively less-apparent body parts. To explore this etymological phenomenon, this report assesses anatomical terminology derived from some of the most apparent structures of the human body-hairs. Hair-related anatomical terminology involves varied etymons, roots, and derivatives: calvus "bald," cilia "eyelashes," glaber "hairless," pilus "hair," pubes (historically referring to the developing beard), pudendum "modesty" (referring to hair growth that covers genitalia), tempus "time" (referring to the location where hair commonly grays, thus showing a person's age), and tragus "goat" (referring to the tuft of hair that resembles the beard of a goat)...

OBJECTIVE: This retrospective study evaluated the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar disc herniation (LDH). METHODS: Data of 107 LDH patients admitted to the People's Hospital of Pingyang between July 2019 and May 2023 were analyzed retrospectively, including 51 cases treated with conventional open discectomy (control group) and 56 cases undergoing PTED (research group). We compared curative effects, operation time, intraoperative blood loss (IBL), incision length, time until ambulation, hospital stay, pre- and post-treatment pain intensity, lumbar function, and complications...

INTRODUCTION: Optimal management of transverse sacral fractures (TSF) remains inconclusive. These injuries may present with neurological deficits including cauda equina syndrome. We present our series of laminectomy for acute TSF with cauda equina compression. METHODS: This was a retrospective chart review of all patients that underwent sacral laminectomy for treatment of cauda equina compression in acute TSF at our institution between 2007 through 2023. RESULTS: A total of 9 patients (5 male and 4 female) underwent sacral laminectomy to decompress the cauda equina in the setting of acute high impact trauma...

Even though epidural blood patch (EBP) is thought to be the definitive treatment for severe cases of postdural puncture headache (PDPH), it may be accompanied by complications like adhesion arachnoiditis, and cauda equina syndrome, especially if the injection is repeated. The sphenopalatine ganglion (SPG) block is a new minimally invasive technique for the treatment of PDPH, with variable results according to the clinical situation and deployed approach. We describe a case of PDPH resistant to EBP in which we successfully managed symptoms using ultrasound-guided suprazygomatic SPG block to deliver local anesthetic directly into pterygopalatine fossa, thus avoiding a second EBP...

Ewing sarcoma is the second most frequent primary bone tumour of childhood and adolescence. The aim of this report is to describe the imaging, pathology, clinical findings, and treatment of a primary intradural extramedullary Ewing sarcoma with a unique intracranial metastatic component in a pediatric patient. A 14-year-old girl with a history of mood disorders presented to the emergency department with a 3-week history of neck torticollis, cervical pain, paresis, and paresthesia of the upper and lower extremities on the left side...

BACKGROUND: Intradural, extramedullary capillary hemangiomas of the cauda equina are exceedingly rare malformations arising from the endothelial cells of the nervous system vasculature. Roughly 20 cases have been reported in the literature, with the youngest and only pediatric case being in a 17-year-old patient. We report the youngest case of intradural extramedullary capillary hemangioma of the cauda equina in a 14-year-old patient. CASE DESCRIPTION: A 14-year-old female presented with two-month history of low back pain with bilateral leg pain and numbness...

BACKGROUND: Pediatric intraspinal epidermoid cysts are rare with potential to cause life-altering outcomes if not addressed. Reports to date describe symptomatic presentations including loss of bladder or bowel function and motor and sensory losses. This case report identifies the diagnostic challenge of an asymptomatic intraspinal epidermoid cyst in the cauda equina region presenting in a 7-year-old male with juvenile idiopathic arthritis (JIA). DIAGNOSIS: An advanced physiotherapist practitioner assessed and diagnosed a previously healthy 7-year-old-male of South Asian descent with JIA based on persistent knee joint effusions...

INTRODUCTION: Cauda Equina Syndrome (CES) is one of the genuine orthopaedic emergencies. Diagnosis of acute CES is challenging and may be missed, resulting in considerable medicolegal claims. In Ireland, nearly €21 million in compensation has been paid out over a 10-year period due to the diagnosis being missed. As a result, defensive practices have resulted in an increased number of referrals for CES to the on-call orthopaedic service in a major trauma unit. METHODS: A prospective data-capturing exercise was carried out of all referrals for acute CES to the orthopaedic on-call department in a tertiary-level university-affiliated teaching hospital between August and November 2023...

PURPOSE: Thoracolumbar traumatic spondylolisthesis is a relatively rare phenomenon and has poor prognosis due to serious spinal cord or cauda equina injuries. In such cases, closed reduction is a method for restoring the vertebral sequence and may play an important role in the treatment process, although whether it is actually feasible for patients with this condition requires further investigation. The present study included 9 patients with serious thoracolumbar traumatic spondylolisthesis to determine the advantages of closed reduction over total reduction through open surgery...

Neurogenic intermittent claudication (NIC), a classic symptom of lumbar spinal stenosis (LSS), is associated with neuronal apoptosis. To explore the novel therapeutic target of NIC treatment, we constructed the rat model of NIC by cauda equina compression (CEC) method and collected dorsal root ganglion (DRG) tissues, a region responsible for sensory and motor function, for mRNA sequencing. Bioinformatic analysis of mRNA sequencing indicated that upregulated metallothionein 2A (MT2A), an apoptosis-regulating gene belonging to the metallothionein family, might participate in NIC progression...

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BACKGROUND: Autoimmune nodopathy (AN) has emerged as a novel diagnostic category that is pathologically different from classic chronic inflammatory demyelinating polyneuropathy. Clinical manifestations of AN include sensory or motor neuropathies, sensory ataxia, tremor, and cranial nerve involvement. AN with a serum-positive contactin-1 (CNTN1) antibody usually results in peripheral nerve demyelination. In this study, we reported a rare case of AN with CNTN1 antibodies characterized by the presence of CNTN1 antibodies in both serum and cerebrospinal fluid, which is associated with cerebellar dysarthria...

INTRODUCTION: Intradural lumbar disc herniations (IDDH) are unusual and represent less than 0.3% of all lumbar disc herniations. They have a higher incidence of cauda equina syndrome. The possibility of intradural disc herniation is often missed on Magnetic Resonance Imaging (MRI) and during surgery if the size of the disc prolapse is inconsistent with the compression seen on the MRI. In such situations, the possibility of IDDH should be suspected. RESEARCH QUESTION: How to diagnose intradural disc herniation pre-operatively? Surgical techniques if the intra-dural disc herniation is encountered intra-operatively...