Surgical Neurology
Volume 72, Issue 5, November 2009, Pages 520-521

Rare cases of cauda equina syndrome

Recai Ates MDa, Steven Van Volsem MDb, Cristo Chaskis MDa and Jean D'Haens MDa. aASZ Aalst. bSt. Franciskus Ziekenhuis, Heusden-Zolder. © 2009 Published by Elsevier Inc.

Introduction

Cauda equina syndrome (CES) is on itself a rare entity, mostly caused by trauma, lumbar stenosis and/or disc herniation, needing an urgent surgical decompression. Recently we've treated 3 patients presenting a CES due to exceptional reasons.

Material and methods

3 patients presenting varying patterns of lower extremity motor weakness, saddle anesthesia, leg pain and urinary sphincter malfunction are treated in our department.

Starting with “benign” symptoms like low back pain without any alarming sign, they gradually deteriorate neurologically to a full blow CES. We report three different etiologies causing the condition: L4 chordoma, dural AV-fistula and a degenerative arthro-synovial cyst. They all are surgically treated on a semi-urgent base.

The patient carrying the L4 chordoma needs a two stage decompression, first a posterior approach with a 2 level pedicular screw stabilization after laminectomy, then an anterior one with a total L4 spondylectomy and tumor resection.

Microsurgical disconnection of the AV-fistula follows after a failed attempt to close the fistula endovascular.

The sticky arhtro-synovial cyst could be removed successfully after a single level laminectomy

Results

The pain symptoms disappear with obvious neurological recuperation in the lower extremities in all three of them. Two patients with moderate bladder dysfunction show no urinary problems anymore short after treatment.

Conclusion

The onset of CES is not always sudden with sometimes difficulties in diagnostic and therefore not always treated in emergency as suggested in a lot of publications. Surgery is (almost) always necessary, whether it consist decompression or “excluding” the etiology.

CES; L4 chordoma; AV-Fistula; Synovial cyst