Disc fragment migration occurs in 35%-72% of lumbar disc herniations. Most of the herniated disc fragments migrate in the rostal, caudal and lateral directions. Posterior epidural disc fragment migration is a rare finding and posterior migration causing Cauda Equina syndrome is exceptionally rare. We report here on two cases of L4-5 disc fragment posterior epidural migration that caused Cauda Equina syndrome, and this was diagnosed by performing radiological examination, and we also include a review of the related literature.
Intervertebral Disc Displacement ; Polyradiculopathy

Spontaneous fracture of the Silastic shunt catheter is a rare complication of lumboperitoneal shunt. A review of the literature revealed only one case in which spontaneous fracture occurred after this procedure. The authors report a case in which fracture of a lumboperitoneal shunt catheter occurred within the interspinous ligament probably due to repeated tension caused by flexion and extension during lumbar motion. The fractured proximal catheter was located entirely within the intrathecal space exclusively from the level of L1 to S1, and caused incomplete cauda equina syndrome.
Catheters* ; Fractures, Spontaneous* ; Ligaments ; Polyradiculopathy

We have experienced 2 patients with dorsally migrated sequestrated lumbar disc herniation with cauda equina syndrome and obtained a complete motor and sensory recovery after early decompressive laminectomy and discectomy with or without fusion in all cases. The purpose of this paper is to report two unusual cases of lumbar disc herniation that we experienced, and to emphasize the importance of early decompressive surgery for the treatment of cauda equina syndrome accompanied with dorsally migrated sequestrated lumbar disc herniation.
Cauda Equina* ; Diskectomy ; Humans ; Laminectomy ; Polyradiculopathy*

Posterior epidural migration of a sequestrated intervertebral lumbar disc with cauda equina syndrome is quite rare. This paper reports two unusual cases of posterior epidural migration of a sequestrated intervertebral lumbar disc with cauda equina syndrome to emphasize the importance of early diagnosis and complete decompression.
Cauda Equina ; Decompression ; Early Diagnosis ; Polyradiculopathy

We report two patients with cauda equina syndrome (CES) secondary to L5 giant cell tumour (GCT) who achieved good neurological recovery after treatment with denosumab without surgery. The first patient was a 26-year-old man with L5 GCT causing CES who regained bowel and urinary control, muscle power improvement from grade 2 to grade 4 and Oswestry disability index (ODI) improvement from 48 to 23 after denosumab treatment. The second patient was a 25-year-old woman with L5 GCT causing CES who regained bowel and urinary control, muscle power improvement from grade 0 to grade 4 and ODI improvement from 42 to 20 after denosumab treatment. The usage of denosumab in the treatment of patients with CES due to GCT allows potential neurological recovery without any surgical intervention. If surgery is not contraindicated, more time is obtained to prepare the patient preoperatively to attain safer surgery and to achieve complete tumour clearance.
Adult ; Cauda Equina* ; Denosumab* ; Female ; Giant Cells* ; Humans ; Polyradiculopathy* ; Spine*

STUDY DESIGN: Review of literature on anatomical and pathophysiological features of cauda equina. OBJECTIVES: To look into the anatomical and pathophysiological features of cauda equina and support their basic knowledge of treating cauda equina syndrome. SUMMARY OF LITERATURE REVIEW: Cauda equina has different anatomical and pathophysiological features to peripheral nerve. MATERIALS AND METHODS: Review of literature. RESULTS: When compressing to cauda equina, the pathophysiologic mechanism develop as follows; increasing the vascular permiablity of nerve root, intraneural edema, and subsequent blood and nutritional impairment. Nerve root injury develops through this pathophysiologic mechanism. CONCLUSIONS: Cauda equina has an extensive ateriovenous anastomosis and guaze-like pia mater, which supply blood and neutrition to it. These anatomical features prevent it from complete cauda equina syndrome when compressing to it under arterial blood pressure.
Arterial Pressure ; Cauda Equina* ; Edema ; Peripheral Nerves ; Pia Mater ; Polyradiculopathy

STUDY DESIGN: A literature review. OBJECTIVES: To describe the causes and clinical characteristics of cauda equina syndrome. SUMMARY OF LITERATURE REVIEW: The cauda equina syndrome, complex symptoms and signs expressed as variable clinical manifestation, has rare incidence but needs attention since it can bring about serious complications and sequales if neglected. MATERIALS AND METHODS: The Author reviewed articles reporting the causes and clinical manifestation of cauda equina syndrome. RESULTS: There are marked inconsistencies in the current evidence base surrounding the definition due to various clinical presentation of cauda equina syndrome. CONCLUSION: As there is no symptom or sign which has an absolute diagnostic value in establishing the diagnosis of cauda equina syndrome, any patient in whom a clinical suspicion of cauda equina syndrome arises must undergo urgent magnetic resonance imaging for diagnosis.
Cauda Equina* ; Diagnosis ; Humans ; Incidence ; Magnetic Resonance Imaging ; Polyradiculopathy*

Method of management of the spine injury should be determined, based on the status of neurological injury as well as on the presence of traumatic instability. At the thoracic and lumbar spine, patterns of neurological injury are different from the cervical spine due to their neuro-anatomical characteristics. Especially, at the thoracolumbar junction, neurological injury patterns with their respective prognosis vary from the complete cord injury or conus medullaris syndrome to the cauda equina syndrome according to the injury level. The concept of Holdsworth's instability based on the posterior ligament complex theory has evolved into the current 3-column theory of Denis. Flexion-rotation injury and fracture-dislocation are well known to be unstable that surgical fixation is frequently needed for these injuries. However, there have been some controversies for the stability of burst fractures and their treatment, such as indirect or direct decompression and anterior or posterior approach. In this article, current concepts and management of traumatic instabilities at the thoracic and lumbar spine have been reviewed and summarized.
Decompression ; Ligaments ; Polyradiculopathy ; Prognosis ; Spinal Cord Compression ; Spine*

Spinal epidural abscess is an uncommon, but a significant disease due to its high morbidity and mortality rate if not diagnosed in time. Although early diagnosis and prompt surgical intervention is needed for better prognosis of this disease, the diagnosis of spinal epidural abscess is often elusive despite modern medical advances, and depends on a high index of suspicion. we report a case of lumbar spinal epidural abscess of unknown origin complicated by cauda equina syndrome.
Cauda Equina* ; Diagnosis ; Early Diagnosis ; Epidural Abscess* ; Mortality ; Polyradiculopathy* ; Prognosis

Cauda equina syndrome(CES) and disc rupture have been implicated as a potential complication of spinal manipulation. A review of the literature from 1911 to 1996 received 61 reported cases of cauda equina syndrome or disc rupture in patients undergoing manipulation. This article presents four new cases, where a temporal association was found between the onset of cauda equina symptoms or disc rupture and lumbar manipulation. The type of manipulation administered and the relationship between the treatment and symptoms is reviewed. Our patients symptoms suggest that acute herniation was caused, or at least precipitated by spinal manipulation. In each of these cases the chiropractitioner failed to comprehend the nature of the problem and take appropriate action. As a consequence, the patient went untreated for several days. Many chiropractic therapists assumed the incidence of CES caused by manipulation to be approximately one in many millions of treatments. However, we assumed that CES or disc rupture is far more common than the literature would reflect. It is therefore essential that persons practicing or prescribing manipulation would be aware of these complications.
Cauda Equina ; Chiropractic ; Humans ; Incidence ; Manipulation, Spinal ; Polyradiculopathy ; Rupture ; Spine*