Cauda equina lesions as a complication of spinal surgery

Abstract

Although the most common aetiology of cauda equina lesions is lumbar intervertebral disc herniation, iatrogenic lesions may also be the cause. The aim of this study was to identify and present patients in whom cauda equina lesions occurred after spinal surgery. From the author's series of patients with cauda equina lesions, those with the appearance of sacral symptoms after spinal surgery were identified. To demonstrate lesions more objectively, electrodiagnostic studies were performed in addition to history and clinical examination. Imaging studies were also reviewed. Of 69 patients from the series, 11 patients in whom a cauda equina lesion developed after spinal surgery were identified. The aetiology comprised surgery for herniated intervertebral disc in 5 (4 performed by a single surgeon), spinal stenosis surgery in 4, and postoperative lumbar epidural haematoma in 2 patients (each performed by a different surgeon). Proportion of spinal surgeries with this complication varied from 0 to 6.6% in different centres. Patients with iatrogenic cauda equina lesion were significantly older (p \ 0.001), and reported more severe urinary, but similar bowel and sexual symptoms compared to other patients in the series. In conclusion the study identified spinal surgery as the cause of approximately 15% of cauda equina lesions. More than a third of lesions developed after procedures performed by a single surgeon. Most of the remaining lesions could probably be avoided by better surgical technique (e.g. the use of a high-speed drill instead of a Kerrison rongeur in patients with severe spinal stenosis), or prevented by closer postoperative monitoring (e.g. in patients with postoperative lumbar epidural haematoma).

Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia

“…Small window surgeries are not recommended in CES and wider conventional opening may precipitate an instability 6 , 26 , 27 . Manipulation is dreaded and one report of spinal surgery itself as the cause of approximately 15% of the total numbers of CES brings to notice the true under-reporting in literature 28 . Trans-dural technique to avoid retraction has also been reported 1 , 20 .…”

Does a history of lumbar spine surgery predict radiological cauda equina compression in patients undergoing MRI for suspected cauda equina syndrome?

“…Changes in biomechanics and local physiology post-operatively could also predispose certain patients to CES symptoms without radiological compression. One study found acute CES to occur in up to 6.6% of post-lumbar surgery patients and also suggested that it may be commoner in those with pre-existing spinal stenosis due to post-operative oedema or venous congestions [Podnar 2001].…”

Cauda equina syndrome after L5-S1 posterior decompression surgery showing a “convexity sign” caused by engorgement of the ventral epidural venous plexus: A case series

“…Cauda equina syndrome (CES) is rarely seen in patients following lumbar surgery. [ 1 , 3 , 4 ] Here, we present four patients who, following L5S1 posterior decompressions, developed CES uniquely attributed to marked engorgement of the ventral epidural venous plexus documented on magnetic resonance images by the “convexity sign,” CES resolved spontaneously in three patients, but warranted a laminoplasty- decompression in the fourth.…”