Synovial cysts and the lithotomy position causing cauda equina syndrome

Wills, John S.; Wiesel, Saul; Abram, Stephen E.; Rupp, Frederick W.

doi:10.1016/j.rapm.2004.01.015

Cited by 4 publications

(1 citation statement)

References 11 publications

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“…[7,8] In fact, patients presenting to the emergency department with isolated low back pain rarely require urgent or emergent neurosurgical intervention,[11,14,31] yet there is a myriad of CES causes that can present with subacute or vague pain and symptomatology. Some well-documented etiologies include lesions such as intracanalicular hemorrhages,[12,25] tumors,[26,44,48] cysts,[37,53] lipomatosis,[52] infection,[1] and even perineural spread of endometriosis. [46] Moreover, inflammatory and degenerative conditions that lead to stenosis such as ankylosing spondylitis,[29] Paget’s disease,[39] osteoporotic stress fracture,[38] and hypertrophic degenerative stenosis[24] have also been well recognized in literature.…”

Section: Discussionmentioning

confidence: 99%

DistalCauda equinasyndrome: A case report of lumbosacral disc pathology and review of literature

Benko¹,

Danison²,

Marvin³

et al. 2019

Surgical Neurology International

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Background: Cauda equina syndrome (CES) is an uncommon entity that presents acutely with all or some of the following symptoms; urinary incontinence from retention, fecal incontinence from loss of sphincter tone, saddle area hypoesthesia or anesthesia, and acute or progressive weakness in one or both lower extremities. The protean symptomatology is often mixed and is vulnerable to confounding comorbidities making the accurate and timely diagnosis of this syndrome uniquely challenging. Here, we present the case of a man who developed isolated sacral nerve dysfunction from CES in the midst of a diabetic crisis. Case Description: A 53-year-old male with a long history of uncontrolled Type 2 diabetes presented with acute-onset urinary and fecal incontinence, scrotal anesthesia, and a 3-day history of lower back pain with intermittent bilateral leg pain. This patient displayed no objective changes in leg strength, sensation, or reflexes. In addition, the patient tested positive for cocaine and had a blood glucose level of 800 mg/dL which confounded his clinical picture. The patient underwent bilateral laminectomies from L4–S1 with the removal of a large sequestered disc fragment from the S1–S2 disc space within 8 h of presentation with reasonable recovery. Conclusion: Highly variable presentations often confound the accurate and timely diagnosis of CES with severe implications on quality of life. Despite the limited functional recovery seen after surgical decompression, urgent or emergent intervention is paramount for treatment. Our patient’s presenting symptomatology and comorbidities highlight the need for practitioners to maintain a high index of suspicion in anyone with incontinence and back pain, regardless of distractors and even in the absence of other anticipated motor or sensory findings.

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Section: Discussionmentioning

confidence: 99%

DistalCauda equinasyndrome: A case report of lumbosacral disc pathology and review of literature

Benko¹,

Danison²,

Marvin³

et al. 2019

Surgical Neurology International

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Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine

Neal

2008

Regional Anesthesia and Pain Medicine

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Neurogenic Bladder

Justiz

Taylor

Day

2010

Anesthesia &Amp; Analgesia

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We describe the case of a 73-year-old woman with a history of chronic low back pain and 2 previous lumbar fusions who presented with complaints of worsening back and leg pain. Having previously undergone multiple interventions, physical therapy, and oral analgesics with limited pain relief, the patient opted for endoscopic lysis of adhesions for severe scarring of the epidural space. Subsequently, the patient developed a neurogenic bladder with urinary retention. Three years later, she experienced resolution of the neurogenic bladder symptoms that coincided with the use of the antibiotic nitrofurantoin. Upon discontinuation of the antibiotic, the patient noted that she was unable to void spontaneously. With reinstitution of nitrofurantoin, the patient was once again able to void effectively and has been maintained on nitrofurantoin for >3 years.

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Synovial cysts and the lithotomy position causing cauda equina syndrome

Cited by 4 publications

References 11 publications

DistalCauda equinasyndrome: A case report of lumbosacral disc pathology and review of literature

DistalCauda equinasyndrome: A case report of lumbosacral disc pathology and review of literature

Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine

Neurogenic Bladder

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