Comment on “Cauda equina syndrome: an uncommon cause of urinary retention in a young woman”

We have presented a case of rare dorsally sequestrated lumbar disc herniation manifesting as cauda equina syndrome. The patient was admitted to the Neurological Department of Canton Hospital Zenica due to urinary retention and weakness in both lower extremities. Magnetic resonance imaging showed a compressing mass located in the dorsal extradural space at the L2- L3 level. An extruded intervertebral disc was found intraoperatively. The decompression was followed by good recovery.

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Resolution of cauda equina syndrome after surgical extraction of lumbar intrathecal bullet

Surgical Neurology International ◽

10.25259/sni_400_2020 ◽

2020 ◽

Vol 11 ◽

pp. 214

Author(s):

Zaid Aljuboori ◽

Emily Sieg

Keyword(s):

Lower Extremity ◽

Urinary Retention ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Spinal Column ◽

Neurological Damage ◽

Burning Pain ◽

Extensor Hallucis Longus ◽

Surgical Extraction ◽

The Right

Background: Gunshot wound (GSW) injuries to the spinal column are correlated with potentially severe neurological damage. Here, we describe a GSW to the thoracolumbar junction (e.g., T12/L1 level) which resulted in a cauda equina syndrome that resolved once the bullet was removed. Case Description: A 29-year-old male presented with a T12-L1 GSW; the bullet traversed the right chest and liver, entered the spinal canal at T12, and then settled at L1. He experienced excruciating burning pain in the right lower extremity/perineum and had urinary retention. On neurological examination, he exhibited severe weakness of the right iliopsoas/quadriceps (2/5) and extensor hallucis longus (1/5) which had decreased sensation in the right lower extremity in all dermatomes and urinary retention. The myelogram showed the bullet lodged intrathecally at L1; it compressed the cauda equina. Immediately after, the bullet was extracted and at 8 weeks follow-up, the patient’s right-sided motor function normalized, the sensory findings improved, and the sphincteric dysfunction resolved; the only residual deficit was minimal residual numbness in the L2-L5 distributions. Conclusion: Twenty percent of penetrating spinal column injuries are attributed to GSW s. The location of these injuries best determines the neurological damage and degree of recovery. Since patients with incomplete cauda equina syndromes have favorable prognoses, removal of bullets involving the T12-S1 levels may prove beneficial.

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P31 Cauda equina syndrome – the importance of an early, accurate diagnosis and treatment in preventing bladder dysfunction

BJS Open ◽

10.1093/bjsopen/zrab032.030 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Victoria Amy Porter ◽

Victoria Porter

Keyword(s):

Urinary Retention ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Accurate Diagnosis ◽

Diagnostic Methods ◽

Diagnosis And Treatment ◽

Decompressive Surgery ◽

Bladder Function ◽

Urological Complications ◽

Significant Difference

Abstract Introduction Cauda Equina Syndrome (CES), is a neurological emergency with many urological features. Delayed decompressive surgery can cause urinary retention, overflow incontinence, long term catherization and loss of sexual function. This article focusses on the accuracy of the initial diagnosis and the time taken before treatment is commenced. Methods In this systematic literature review, OneSearch and PubMed have been searched for articles which identify the main symptoms of CES, evaluate the effectiveness of several diagnostic methods and compare the postoperative results of bladder function following timely and delayed treatment. Results A total of 20 articles have been referenced, of which 9 studies have been reviewed. While no individual symptom is 100% indicative of CES, urinary retention (diagnostic accuracy 0.9), is the most consistent clinical finding. Therefore, MRI is necessary for an accurate diagnosis. Further 4 out of 5 studies state that treatment within 24-hours improves patient outcomes compared to 48-hours, one study showed no significant difference between 24 and 48 hours. All articles indicate beyond 48-hours, surgical intervention has little impact on the relief of symptoms. Conclusion The studies concluded that any patient presenting in the emergency department with lower back pain should be screened for CES. A thorough history and neurological examination should be performed; however, the evidence base for rectal examination to assess anal tone is poor. Decompressive surgery carried out within the first 24-hour period from the onset of symptoms is favourable. Overall, early accurate diagnosis and treatment is invaluable to preventing urological complications and improving prognosis.

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Incomplete Cauda Equina Syndrome Presenting with Acute Urinary Retention in the Emergency Department

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791001700513 ◽

2010 ◽

Vol 17 (5) ◽

pp. 498-501 ◽

Cited By ~ 1

Author(s):

H Cιftcι ◽

A Ozgonul ◽

O Sogut ◽

M Savas

Keyword(s):

Emergency Department ◽

Urinary Retention ◽

Cauda Equina Syndrome ◽

Acute Urinary Retention ◽

Cauda Equina

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Postoperative urinary retention in patients undergoing elective spinal surgery

Journal of Neurosurgery Spine ◽

10.3171/2016.8.spine151371 ◽

2017 ◽

Vol 26 (2) ◽

pp. 229-234 ◽

Cited By ~ 26

Author(s):

David Altschul ◽

Andrew Kobets ◽

Jonathan Nakhla ◽

Ajit Jada ◽

Rani Nasser ◽

...

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Urinary Retention ◽

Spine Surgery ◽

Spinal Surgery ◽

Cauda Equina Syndrome ◽

Foley Catheter ◽

Cauda Equina ◽

Leg Pain ◽

Postoperative Urinary Retention

OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular vigilance when they are due to void postprocedure. A greater understanding of POUR may also prevent longer hospital stays in select at-risk patients. Postoperative retention is rarely caused by a postoperative cauda equina syndrome due to epidural hematoma, which is also associated with saddle anesthesia, leg pain, and weakness, yet the delineation of isolated POUR from this urgent complication is necessary for optimal patient care.

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Acute piriformis syndrome mimicking cauda equina syndrome: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21252 ◽

2021 ◽

Vol 2 (17) ◽

Author(s):

Jan Lodin ◽

Štěpánka Brušáková ◽

David Kachlík ◽

Martin Sameš ◽

Ivan Humhej

Keyword(s):

Urinary Retention ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Pelvic Trauma ◽

Illustrative Case ◽

Piriformis Syndrome ◽

Patient History ◽

Pelvic Region ◽

Magnetic Resonance Imaging Mri ◽

Motor Disturbances

BACKGROUND This report depicts a rare case of acutely developed urinary retention as well as sensory and motor disturbances caused by formation of a large hematoma within the piriformis muscle, which caused compression of nerves within the suprapiriform and infrapiriform foramina, thus imitating cauda equina syndrome. Although cases of acute lumbosacral plexopathy have been described, this case is the first time both urinary retention and sensory and motor disturbances were present. OBSERVATIONS The most useful tools for diagnosis of acute piriformis syndrome are detailed patient history, magnetic resonance imaging (MRI) of the pelvic region, and electrophysiological testing performed by an experienced electrophysiologist. As a result of diligent rehabilitation, including physiotherapy and electrostimulation, the patient was able to successfully recover, regardless of acute compression of the sacral plexus that lasted 6 days. LESSONS Clinicians should actively ask about previous pelvic trauma when taking a patient history in similar cases, especially if the patient is receiving anticoagulation treatment. If MRI of the lumbar spine does not reveal any pathologies, MRI of the pelvic region should be performed. Acute surgical decompression is crucial for preserving neurological function. In similar cases, it is possible to differentiate between spinal cord, cauda equina, and pelvic lesions using electrophysiological studies.

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Hemi-Cauda Equina Syndrome from Herniated Lumbar Disc: a Neurosurgical Emergency?

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100038257 ◽

1996 ◽

Vol 23 (4) ◽

pp. 296-299 ◽

Cited By ~ 23

Author(s):

Ronald H.M.A. Bartels ◽

Joost de Vries

Keyword(s):

Urinary Retention ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina ◽

Leg Pain ◽

Motor Deficit ◽

Duration Of Symptoms ◽

Radiographic Findings ◽

Herniated Lumbar Disc ◽

Symptoms And Signs

AbstractBackground: We report experience with patients presenting with a specific combination of symptoms: unilateral sciatica, unilateral sensibility loss in the dermatomes SI to S5 (hemi-saddle) and subjective micturation problems secondary to ruptured lumbar disc. Because of its similarities with a cauda equina syndrome, this combination of symptoms was thought to be a unilateral cauda equina syndrome and it was called hemi-cauda equina syndrome. Consequently, it was treated as an emergency. Methods: Ten patients were evaluated. They compromised 2.3% of all patients undergoing lumbar discectomy. Results: Outcome is good with only 10% persisting minor neurologic deficit (sensibility loss in dermatomes S3 to S5). With the exception of urinary retention or incontinence, duration of symptoms and signs does not seem to influence outcome. Comparing signs, symptoms and radiographic findings with those of a cauda equina syndrome which were recently and thoroughly studied, they were found to be more severe in cases of cauda equina syndrome. Especially, the good outcome, (apparently unrelated to the duration of symptoms in cases of hemi-cauda equina syndrome) contrasted with the treatment results of cauda equina syndrome. Conclusions: We defined the hemi-cauda equina syndrome from ruptured disc as a combination of unilateral leg pain, unilateral sensibility loss in dermatomes SI to S5 and sphincter paralysis (proven urinary retention or incontinence). Motor deficit is not necessarily present. Emergency surgery is warranted. Patients presenting with micturation complaints other than urinary retention or incontinence do not suffer from a hemi-cauda equina syndrome.

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Timing of surgery in cauda equina syndrome with urinary retention: meta-analysis of observational studies

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/4/305 ◽

2008 ◽

Vol 8 (4) ◽

pp. 305-320 ◽

Cited By ~ 80

Author(s):

W. Bradford DeLong ◽

Nayak Polissar ◽

Blažej Neradilek

Keyword(s):

Urinary Retention ◽

Cauda Equina Syndrome ◽

Evidence Synthesis ◽

Meta Analysis ◽

Cauda Equina ◽

Timing Of Surgery ◽

Surgical Timing ◽

Best Evidence Synthesis ◽

Fair Poor ◽

Meta Analyses

Object The authors performed exploratory meta-analyses of observational cohort studies, evidence level III, examining whether earlier surgery makes a difference in outcome in terms of urinary function once cauda equina syndrome (CES) from a herniated lumbar disc has progressed to urinary retention (CESR). Methods Literature search identified 27 studies of CESR patients with clear definition of surgical timing. Relative risk (RR) could not be calculated in 11 studies, leaving 16 for meta-analysis. Urinary retention related to surgical timing at 5 breakpoints: 12, 24, 36, 48, or 72 hours. Urinary outcome was classified as Normal, Fair, or Poor. Meta-analysis was performed for “Event = Fair/Poor” or “Event = Poor.” Eight studies allowed separation into CESR and incomplete CES (CESI), and 5 of these had enough data for meta-analysis to compare CESR and CESI. A random effects meta-analysis model was used because of heterogeneity across the studies. A best-evidence synthesis was performed for the 4 largest studies that had 24- and 48-hour breakpoints. Results For “Event = Fair/Poor,” meta-analyses using the 5 breakpoints predicted a more likely Fair/Poor outcome for later surgery (RR range 1.77–2.19). The RR for later timing of surgery was statistically significant for 24-and 72-hour breakpoints and was elevated but not statistically significant for the other 3. For “Event = Poor,” the RR range was 1.09–5.82, statistically significant for the 36 hour breakpoint only. Meta-analysis comparing CESR patients with CESI patients predicted a Fair/Poor result for CESR (RR 2.58, 95% confidence interval 0.59–11.31). The best-evidence synthesis did not disclose reasons for differences in the results of the 4 studies. Conclusions This study supports early surgery for CES and indicates that CESR and CESI cases should not be analyzed together.

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