Yuan Tianyang, Zhang Jun, Yang Lili, Wu Jiuping, Tian Haiqing, Wan Teng, Xu Derui, Liu Qinyi
Department of Orthopaedics, The Second Hospital, Jilin University, Changchun, Jilin, China.
Medicine (Baltimore). 2019 Jul;98(29):e16396. doi: 10.1097/MD.0000000000016396.
Cauda equina syndrome (CES) refers to a group of symptoms that occur when the nerves in the cauda equina become compressed or damaged. The most common etiology of CES is lumbar intervertebral disc herniation, but CES following lumbar spinal surgery is rare, especially without motor dysfunction. Herein, we illustrate a case of CES that developed as a complication of spinal surgery and to deduce its possible underlying cause.
A 46-year-old man experienced lumbago, bilateral shank pain, and numbness with neurogenic claudication for 3 years due to degenerative lumbar disc herniation and spinal cord stenosis. After a thorough examination to diagnose lumbar spinal stenosis, the patient underwent bilateral decompression and pedicle screw system internal fixation with bone graft. Postoperatively, the patient showed regained strength in his bilateral shanks, and he did not complain of lumbago and shank pain, but CES occurred, which manifested as underpants-type numbness in the perineum without bladder, anal, and motor dysfunction.
CES as a postoperative complication of lumbar stenosis.
The patient underwent bilateral laminectomies, partial facetectomies, and pedicle screw system internal fixation and fusion with bone graft. Postoperatively, the patient performed adequate rehabilitation exercises and was expected to recover spontaneously.
The symptoms of pain and claudication resolved after 3 weeks in the hospital, but an underpants-type hypoesthesia in the perineum without motor dysfunction developed. The patient experienced full recovery from CES 6 months after surgery.
CES as a complication of lumbar spinal surgery is very rare. Excessive sensitivity to the traction of the dural sac was, in our opinion, the most possible cause of postoperative CES in this case. When the nerve root is pulled intraoperatively, it is best not to cross the central line of the spinous process. The plane of the nerve retractor needs to be parallel to the dural sac at the pulling point to reduce the formation of shear force. Most importantly, gentle maneuver is required because sensitivity to the traction of the dural sac varies individually.
马尾综合征（CES）是指马尾神经受压或受损时出现的一组症状。CES最常见的病因是腰椎间盘突出症，但腰椎手术后发生CES的情况很少见，尤其是没有运动功能障碍的情况。在此，我们阐述了一例作为脊柱手术并发症发生的CES病例，并推断其可能的潜在原因。
一名46岁男性因退行性腰椎间盘突出症和脊髓狭窄，出现腰痛、双侧小腿疼痛及麻木伴神经源性间歇性跛行3年。在经过全面检查诊断为腰椎管狭窄后，患者接受了双侧减压、椎弓根螺钉系统内固定及植骨手术。术后，患者双侧小腿力量恢复，且不再抱怨腰痛和小腿疼痛，但出现了CES，表现为会阴部内裤型麻木，无膀胱、肛门及运动功能障碍。
CES作为腰椎管狭窄术后并发症。
患者接受了双侧椎板切除术、部分关节突切除术、椎弓根螺钉系统内固定及植骨融合手术。术后，患者进行了充分的康复锻炼，并有望自行恢复。
患者住院3周后疼痛和间歇性跛行症状消失，但出现了会阴部内裤型感觉减退且无运动功能障碍。患者术后6个月CES完全恢复。
CES作为腰椎手术的并发症非常罕见。我们认为，对硬脊膜囊牵张过度敏感是该病例术后发生CES的最可能原因。术中牵拉神经根时，最好不要越过棘突中线。神经牵开器的平面在牵拉点处需与硬脊膜囊平行，以减少剪切力的形成。最重要的是，由于对硬脊膜囊牵张的敏感度因人而异，操作时需要轻柔。
