Abstract
Study design
Case report.
Objective
To highlight the concept of Cauda Equina Syndrome without cauda compression.
Summary of background data
Cauda equina syndrome (CES) is a rare disorder. CES occurs usually due to direct physical compression of the cauda nerve roots, most often from the extruded nucleus pulposus; other rare causes reported in the literature include compression by tumour, infection, fracture, penetrating trauma, chiropractic manipulation, free epidural fat graft, postoperative haematoma, ankylosing spondylitis, metastatic invasion, schwnnoma, Paget’s disease and laminar hook compression. All these causes of CES physically compress the cauda. Chemical irritation of the root can cause radicular pain but this has not been noted to cause CES before. We present two cases of Cauda Equina Syndrome was brought on by non-physical compression of the cauda. Annular tears can induce CES by chemical irritation of the cauda by inflammatory mediators.
Conclusion
The idea of presenting this paper is to highlight that cauda equina syndrome can be caused by non-mechanical cauda compression; in our cases it was due to chemical irritation and caudal epidural steroid injection has produced satisfactory outcome. Awareness of non-physical cauda equina syndrome is essential to identify and to initiate appropriate treatment, and the outcome seems to be satisfactory.
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References
Boden SD, Davis DO, Dina TS et al (1990) Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. J Bone Joint Surg Am 72(3):403–408
Boumphery FRC, Bell GR, Modic M et al (1987) Computed topography scanning after chymopapain injection for herniated nucleus pulpous: a prospective study. Clin Orthop Relat Res 219:120–123
Delamarter RB, Sherman JE, Carr JB (1991) Cauda equina syndrome: neurological recovery following immediate, early, or late decompression. Spine 16(9):1022–1029
Floman Y, Wiesel SW, Rothman RH (1980) Cauda equina syndrome presenting as a herniated lumbar disc. Clin Orthop Relat Res 147:234–237
Getzbein SD, Tile M, Gross A, Falk R (1975) Auto-immunity in degenerative disc disease of the lumbar spine. Orthop Clin North Am 6:67–73
Igarashi T, Kikuchi S, Shubayev V et al (2000) Exogenous tumour necrosis factor––alpha mimics nucleus pulposus-induced neuropathology: molecular, histologic, and behavioral comparisons in rats. Spine 25:2975–2980
Karppinen J, korhonen T, Malmivaara A et al (2003) Tumour necrosis factor-alpha monoclonal antibody, infliximab, used to manage severe sciatica. Spine 28:750–754
Kostuik JP et al (1986) Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg Am 68(3):386–391
Lemma MA, Herzka AS, Tortolani PJ, Carbone JJ (2002) Cauda equina syndrome secondary to lumbar disc prolapse. In: Vaccaro AR, Betz RR, Zeidman SM (eds) Principles and practice of spine surgery, chapter 26. WB Saunders Co, Philadelphia, pp 347–353
MacNab I (1977) The mechanisms of spondylotic pain. In: Hirsh C, Zotterman T (eds) Cervical pain. Permagon Press, Oxford, pp 88–95
McCarron RF, Wimpee MW, Hudkins PG et al (1987) The inflammatory effect of nucleus pulposus: a possible element in the pathogenesis of low back pain. Spine 12:760–764
Meller St, Pechman PS, Gebhart GF et al (1992) Nitric oxide mediates the thermal hyperalgesia produced in a model of neuropathic pain in the rat. Neuroscience 50:7–10
Olmarker K, Rydevik B, Nordborg C (1993) Autologous nucleus pulpous induces neurophysiologic and histologic changes in porcine cauda equina nerve roots. Spine 18:1425–1432
Research on low back pain and common spinal disorders (1997) NIH Guide 16 May, vol 26(16)
Takahashi N, Yabuki S, Aoki Y et al (2003) Pathomechanisms of nerve root injury caused by disc herniation: an experimental study of mechanical compression and chemical irritation. Spine 28(5):435–441
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No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
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Subramanian, S., Chandran, P., Sundaram, R. et al. Cauda equina syndrome without mechanical cauda compression: a report of 2 cases. Eur J Orthop Surg Traumatol 18, 303–306 (2008). https://doi.org/10.1007/s00590-008-0304-y
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DOI: https://doi.org/10.1007/s00590-008-0304-y