Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China (S-DY, W-YD); Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China (QC); and Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, PR China (W-YD).
Am J Phys Med Rehabil. 2018 Apr;97(4):e23-e26. doi: 10.1097/PHM.0000000000000809.
Cauda equina syndrome (CES) resulting from acute lumbar disc herniation due to spinal massage is extremely rare. We present a case of CES caused by the acute worsening of a lumbar disc herniation after a vigorous back massage that included spinal manipulation. After vigorous back massage with spinal manipulation performed by a massage therapist, a 38-yr-old male patient experienced CES with severe numbness in both lower limbs, inability to walk due to weakness of bilateral lower limbs, and incontinence of urine and feces. The magnetic resonance imaging and computer tomography scan results showed that the L4-5 disc herniated down into the spinal canal, extensively compressing the ventral dural sac. The patient was successfully treated with an emergency operation including laminectomy, spinal canal decompression, discectomy, interbody fusion, and pedicle screw fixation. The muscle power in both lower limbs of the patient recovered rapidly to support standing only 1 wk later. Moreover, he regained continence of urine and feces. In conclusion, this case brings us novel knowledge that spinal massage or manipulation may worsen pre-existing disc herniation causing CES, and a timely emergency surgery is necessary and effective for treatment of CES-related symptoms.
马尾综合征（CES）是由脊柱按摩引起的急性腰椎间盘突出导致的，极为罕见。我们报告了一例 CES 病例，该患者在接受按摩师进行的剧烈背部按摩（包括脊柱手法治疗）后，腰椎间盘突出症急性加重导致 CES。在接受按摩师进行的剧烈背部按摩和脊柱手法治疗后，一位 38 岁男性患者出现 CES，表现为下肢严重麻木、双侧下肢无力导致无法行走，以及尿便失禁。磁共振成像和计算机断层扫描结果显示，L4-5 椎间盘疝入椎管，广泛压迫腹侧硬脊膜。患者接受了紧急手术治疗，包括椎板切除术、椎管减压、椎间盘切除术、椎间融合和椎弓根螺钉固定。术后 1 周，患者下肢肌力迅速恢复，仅能支持站立。此外，他恢复了尿便的自控能力。总之，本病例为我们带来了新的认识，即脊柱按摩或手法治疗可能会使先前存在的椎间盘突出加重，导致 CES，及时进行紧急手术对于治疗 CES 相关症状是必要且有效的。
