Early Results of a Delayed Decompressive Laminectomy for Severe Acute Cauda Equina Syndrome in a 24-Year-Old Man Due to Traumatic Prolapse of Intervertebral Disc at L4/L5 Disc Space in Irrua: A Case Report

Abstract

Ogbue I.A., Enoma E., Nwokike O.C., Ukwa M.U. and Onuminya J.E.

Background: Cauda equina syndrome (CES) is an uncommon but potentially devastating neurological condition caused by compression of the lumbosacral nerve roots. It constitutes a spinal surgical emergency because delayed diagnosis and decompression may result in permanent neurological deficits, including bladder, bowel, and sexual dysfunction, as well as lower-limb paralysis.

Case Report: A 24-year-old single man, a fashion designer presented with a one-day complaints of acute inability to walk, urinary retention, bowel dysfunction, saddle anaesthesia, and bilateral lower limb weaknesses following a domestic fall onto his lower back. Clinical examination revealed bilateral lower-limb weaknesses, reduced reflexes, saddle anaesthesia, and absent anal, bulbocavernosus and Babinski reflexes. Magnetic resonance imaging obtained 5 days after the request owing to financial constraints, demonstrated severe canal compromise with near-complete obliteration of the thecal sac due to massive prolapse at the L4/L5 disc space. He was diagnosed of severe acute CES secondary to traumatic lumbar disc prolapse and he underwent urgent open decompressive noninstrumented laminectomy and limited posterolateral fusion at L4/L5 after one week of injury. Immediate postoperative recovery was dramatic in terms of motor and sensory recovery in the lower limbs, and there was no infection; but there was persistent saddle anaesthesia, absent anal and bulbocavernous reflexes, and weakness in plantar flexion and dorsiflexion at the ankle joints. At 8 weeks follow-up, he attained vertebral fusion and demonstrated progressive neurological recovery and was able to ambulate on a Zimmer frame in spite of the residual sacral neural deficits.

Conclusion: Severe acute cauda equina syndrome secondary to traumatic lumbar disc prolapse is rare and a devastating lesion in a young man, which requires prompt recognition and urgent surgical decompression. This case demonstrates that early useful neurological recovery is achievable despite one-week delay in the timing of surgical intervention in a young man.

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