Acute cauda equina syndrome due to lumbar spinal stenosis caused by prolonged supine position during cardiac catheterization: a case report

International Journal of Case Reports ◽

10.28933/ijcr-2021-03-3006 ◽

2021 ◽

pp. 209

Author(s):

Keyword(s):

Atrial Fibrillation ◽

Low Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Supine Position ◽

Bladder Dysfunction ◽

Cauda Equina ◽

Lower Limbs ◽

Low Back ◽

Lumbar Spinal

Background: Cauda equina syndrome (CES) is a severe neurologic condition marked by progressive loss of function of the neurologic elements in the spinal canal below the termination of the spinal cord. This article reports an instructive case of CES with acute aggravation of neuropathy after catheter ablation for atrial fibrillation. Patient concerns: A 63-year-old Japanese man underwent catheter ablation for atrial fibrillation. Because he complained of severe low back pain and numbness in the posterior of both lower limbs while in the supine position, he was given analgesia with pentazocine and sedated with propofol, and the procedure continued. He was then forced to maintain lumbar extension while in the supine position for 13 hours. After the treatment, he noticed urination disor-der, numbness, and paralysis of both lower limbs. Diagnosis: Neurological findings included sensory impairment and motor deficit of L5 and below, including bowel/bladder dysfunction. Lumbar magnetic resonance imaging showed severe lumbar spinal stenosis at L4-L5. He was diagnosed with CES due to lumbar spinal stenosis. Interventions: The patient received emergency surgery for L4-L5 decompression. Decompression of the spinal canal was achieved 33 hours after the start of catheterization. Outcomes: The patient’s leg symptoms improved immediately after surgery, and he was able to walk with a walker. On postoperative day 6, the urinary catheter was removed. However, he experienced urinary retention and needed intermittent self-directed urination. Five months after surgery, he was able to urinate on his own, and completed the intermittent self-directed urination. Nine months after surgery, his muscle strength had recovered almost completely, and he was able to walk with a cane. However, bladder dysfunction such as frequent urination and residual urination remained 4 years after surgery. Lessons: If the supine position elicits low back pain and leg numbness, the presence of lumbar spinal stenosis should be considered. Forcing patients with such symptoms into a sustained posture can lead to CES.

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Examination Findings and Self-Reported Walking Capacity in Patients With Lumbar Spinal Stenosis

Physical Therapy ◽

10.1093/ptj/81.7.1296 ◽

2001 ◽

Vol 81 (7) ◽

pp. 1296-1306 ◽

Cited By ~ 58

Author(s):

Maura D Iversen ◽

Jeffrey N Katz

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lower Extremity ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Cauda Equina ◽

Low Back ◽

Lower Extremity Weakness ◽

Walking Capacity ◽

Lumbar Spinal

AbstractBackground and Purpose. Spinal stenosis is a common, often disabling, condition resulting from compression of the cauda equina and nerve roots. This study was designed to: (1) characterize the impairments of patients with lumbar spinal stenosis (LSS) and (2) to identify predictors of self-reported walking capacity. Subjects. Forty-three patients with symptomatic LSS, from 3 specialty clinics, were evaluated. Twenty-eight subjects (65%) were female. The subjects' median age was 73.6 years (X̄=72.4, SD=10.3, range=45.–90.7), and the median duration of low back pain was 24 months (X̄=36.6, SD=41.6, range=0–216). Methods. Demographic data, medical history, and information about low back pain and symptoms (eg, numbness, tingling, and lower-extremity weakness) were collected using a standardized questionnaire and physical examination. Results. Twenty-two subjects (51%) had lower-extremity weakness, primarily of the extensor hallucis longus muscle. Thirty-five subjects (81%) had absent or decreased neurosensory responses (eg, pinprick, vibration, reflexes), and 28 subjects (66%) reported that they were unable to walk farther than 2 blocks. Women were more likely than men to report difficulties walking, as were subjects with abnormal Romberg test scores and those with greater pain during walking. Discussion and Conclusion. Pain and balance problems appeared to be the primary factors limiting ambulation in our subjects with LSS.

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Outcomes after decompression surgery without fusion for patients with lumbar spinal stenosis and substantial low back pain

European Spine Journal ◽

10.1007/s00586-019-06130-x ◽

2019 ◽

Vol 29 (1) ◽

pp. 147-152 ◽

Cited By ~ 3

Author(s):

Soichiro Masuda ◽

Yusuke Kanba ◽

Jun Kawai ◽

Noboru Ikeda

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Decompression Surgery ◽

Low Back ◽

Lumbar Spinal

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Predictors of Walking Performance and Walking Capacity in People With Lumbar Spinal Stenosis, Low Back Pain, and Asymptomatic Controls

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2011.09.023 ◽

2012 ◽

Vol 93 (4) ◽

pp. 647-653 ◽

Cited By ~ 34

Author(s):

Christy C. Tomkins-Lane ◽

Sara Christensen Holz ◽

Karen S. Yamakawa ◽

Vaishali V. Phalke ◽

Doug J. Quint ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Low Back ◽

Walking Capacity ◽

Walking Performance ◽

Lumbar Spinal

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Examination of a Regression Model to Quantify the Severities of Low Back Pain and Lower Limb Symptoms in Patients with Lumbar Spinal Stenosis

The Japanese Journal of Rehabilitation Medicine ◽

10.2490/jjrmc.20034 ◽

2021 ◽

Author(s):

Hayato Ishitani ◽

Toshiyo Tamura ◽

Shigehiko Kanaya

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Regression Model ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lower Limb ◽

Low Back ◽

Lumbar Spinal

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Low back pain-related diseases including lumbar spinal stenosis

Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics ◽

10.3143/geriatrics.57.243 ◽

2020 ◽

Vol 57 (3) ◽

pp. 243-253

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Low Back ◽

Lumbar Spinal

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Prevalence, Spinal Alignment, and Mobility of Lumbar Spinal Stenosis with or without Chronic Low Back Pain: A Community-Dwelling Study

Pain Research and Treatment ◽

10.1155/2011/340629 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Naohisa Miyakoshi ◽

Michio Hongo ◽

Yuji Kasukawa ◽

Yoshinori Ishikawa ◽

Yoichi Shimada

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Chronic Low Back Pain ◽

Community Dwelling ◽

Computer Assisted ◽

Low Back ◽

Spinal Alignment ◽

Lumbar Spinal

Although lumbar spinal stenosis (LSS) occurs almost universally with aging, little is known regarding its actual prevalence and relationships to chronic low back pain (CLBP) in the general population. The presence of CLBP in subjects with LSS may have negative impacts on spinal alignment and mobility. This study evaluated the prevalence of LSS using a self-administered, self-reported history questionnaire in 630 community-dwelling individuals ≥50 years old. Subjects with LSS were further divided into LSS+CLBP and LSS alone groups, and spinal alignment and mobility were compared using a computer-assisted device. Prevalence of LSS was 10.8% in this cohort. Subjects in the LSS+CLBP group () showed a significantly more kyphotic lumbar spinal alignment with limited lumbar extension (), resulting in a stooped trunk compared to subjects in the LSS alone group (). However, no significant difference in spinal mobility was seen between groups.

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Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis?

European Spine Journal ◽

10.1007/s00586-013-2786-5 ◽

2013 ◽

Vol 22 (9) ◽

pp. 2010-2014 ◽

Cited By ~ 14

Author(s):

Shunji Tsutsui ◽

Ryohei Kagotani ◽

Hiroshi Yamada ◽

Hiroshi Hashizume ◽

Akihito Minamide ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Decompression Surgery ◽

Degenerative Lumbar Scoliosis ◽

Low Back ◽

Lumbar Scoliosis ◽

Lumbar Spinal

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Nonsurgical Korean Integrative Treatments for Symptomatic Lumbar Spinal Stenosis: A Three-Armed Randomized Controlled Pilot Trial Protocol

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/2913248 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Kiok Kim ◽

Kyung-Min Shin ◽

Jun-Hwan Lee ◽

Bok-Nam Seo ◽

So-Young Jung ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Treatment Program ◽

Leg Pain ◽

Low Back ◽

Randomized Controlled ◽

Medicinal Treatment ◽

Lumbar Spinal

This is a study protocol for a pilot three-armed randomized controlled trial on nonsurgical integrative Korean medicinal treatment for symptomatic lumbar spinal stenosis (LSS). Thirty-six participants who have been diagnosed with (LSS) and recommended for spinal surgery by neurosurgeons or orthopedics and have had spinal symptoms such as severe low back pain and neurological claudication regardless of at least three months of conservative treatments will be recruited. Participants will be randomly assigned to be one of the three intervention groups, including the Mokhuri treatment program group 1 or 2 or usual care group. All treatments will be administered in inpatient units over a period of 4 weeks. The primary outcomes are 0 to 100 Visual Analogue Scales for low back pain and leg pain and the secondary outcomes are Oswestry Disability Index; EQ-5D; Roland-Morris Disability Questionnaire; Oxford Claudication Score; physical function test, including treadmill test, walking duration, and distance assessment for free leg pain; radiologic testing; and adverse events which will be assessed during the 4-week treatment period as well as after 3 and 6 months of follow-up. Then, we will assess the feasibility of the clinical trial design as well as a nonsurgical integrative treatment program. This trial is registered with CRIS registration number: KCT0001218.

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