Sudden Onset of Cauda Equina Syndrome Resulting from Posterior Migration of Lumbar Herniated Disc Without Significant Previous Neurological Signs

Ju, Jeong-Hyuk; Kim, Hyun Woo; Jung, Chul-Ku; Ha, Ho-Gyun

doi:10.14245/kjs.2012.9.3.281

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…CES can occur due to LDH, tumor, or epidural abscess, and so on4). But CES is a rare and severe condition and is considered the absolute surgical indication89).…”

Section: Discussionmentioning

confidence: 99%

The Factors That Affect Improvement of Neurogenic Bladder by Severe Lumbar Disc Herniation in Operation

et al. 2016

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ObjectiveThis study analyzed retrospectively the bladder function of patients after early surgery for cauda equina syndrome (CES) performed within 24 or 48 hours, or after 48 hours of the onset of autonomic symptoms.MethodsWe retrospectively reviewed the clinical data of 31 patients after decompression surgery for lumbar disc herniation (LDH) who had been diagnosed with CES between January 2001 and December 2014 at Inha University Hospital. The following factors were assessed to evaluate the influence of time to surgery: bladder function, rectal incontinence, sexual dysfunction, LDH level, and degree of spinal canal compression.ResultsAfter decompression, the outcome group was categorized into normal bladder function and abnormal bladder function. The patients operated on within 48 hours showed an improved postoperative outcome. Among 16 patients operated on within 48 hours, 13 (81%) recovered normal bladder function. In contrast, among 15 patients with decompression after 48 hours, 6 (40%) recovered normal bladder function. Among 21 patients with mild bladder dysfunction at admission, 16 (76%) recovered normal bladder function after decompression.ConclusionOur study suggests that patients who have decompression surgery within 48 hours of the onset of bladder dysfunction, improve their chances of recovering bladder function than those who have a late operation (>48 hours). Also, patients with mild bladder dysfunction are more likely to recover bladder function after decompression, than patients with severe bladder dysfunction.

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“…CES can occur due to LDH, tumor, or epidural abscess, and so on4). But CES is a rare and severe condition and is considered the absolute surgical indication89).…”

Section: Discussionmentioning

confidence: 99%

The Factors That Affect Improvement of Neurogenic Bladder by Severe Lumbar Disc Herniation in Operation

et al. 2016

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“…However, our first patient did not have such a history. To our knowledge, this is the second instance wherein a patient presents with gross neurological findings as a sequelae to PEMLIF without a history of back pain (11). The PLL, dura, fat, epidural vessels and the nerve roots can act as a barrier for the migration of the disc in the posterior direction.…”

Section: Discussionmentioning

confidence: 77%

PEMLIF—a tale of two stories

et al. 2017

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A 48-year-old man was who had no previous history of back ache was involved in a strenuous activity wherein he had to lift weight of about 25 kg. Following this, he suddenly felt excruciating pain in the lower back radiating down to both his buttocks and knees. After sometime he felt weakness of both lower limbs and could not walk Abstract: Intervertebral disc prolapse is a common cause of both acute and chronic low back pain. This can result in differential grades of motor and sensory disturbances in lower limbs and even cauda equina syndrome (CES). The neurological manifestations are a result of compression of the spinal cord and roots ventrally in the spinal canal due to the prolapsed disc. However, neurologic deficits owing to compression of the spinal cord dorsally as a result of migration of sequestrated disc fragments are very rare. We present two different cases of back pain with severe neurologic deficit referred to us within a short span of one month. Among them, one had long standing history of back pain while other had none. Both patients were investigated and found to have a sequestrated disc fragment which had dorsally migrated to the epidural space and was causing severe compression of the spinal cord. They underwent laminectomy and removal of the sequestrated fragment. However, they were only partially relieved of their motor and bladder weakness.We present our cases to highlight this rare form of lumbar epidural intervertebral disc migration, as well as enumerate the diagnostic challenges and discuss the differential diagnosis and treatment.

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Posterior epidural intervertebral disc migration and sequestration: A systematic review

Palmisciano

Balasubramanian

Scalia

et al. 2022

Journal of Clinical Neuroscience

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Sudden Onset of Cauda Equina Syndrome Resulting from Posterior Migration of Lumbar Herniated Disc Without Significant Previous Neurological Signs

Cited by 5 publications

References 12 publications

The Factors That Affect Improvement of Neurogenic Bladder by Severe Lumbar Disc Herniation in Operation

The Factors That Affect Improvement of Neurogenic Bladder by Severe Lumbar Disc Herniation in Operation

PEMLIF—a tale of two stories

Posterior epidural intervertebral disc migration and sequestration: A systematic review

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