Liu Guanyi, Li Qing, Ruan Hongfeng, Zhu Bingke, Ma Weihu, Hu Yong
Department of Orthopedics, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China.
Department of Endocrinology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China.
Orthop Surg. 2025 Feb;17(2):653-659. doi: 10.1111/os.14343. Epub 2025 Jan 7.
Postoperative spinal epidural hematoma (SEH) is a rare but serious complication following lumbar surgery, with cauda equina syndrome (CES) being one of its most devastating outcomes. While CES typically presents with a combination of bladder and/or bowel dysfunction, diminished sensation in the saddle area, and motor or sensory changes in the lower limbs, atypical cases with isolated urinary symptoms are less recognized and pose significant diagnostic challenges.
We report the case of a 46-year-old male who developed CES following lumbar microdiscectomy, presenting solely with urinary retention, without the classic signs of lower limb weakness or perineal sensory loss. Initial symptoms were attributed to postoperative urinary issues, delaying the diagnosis of CES. On postoperative day 7, magnetic resonance imaging (MRI) revealed SEH, and emergency hematoma evacuation was performed. Despite the delayed intervention, the patient made a full neurological recovery, with bladder and bowel functions restored by 3 months postoperatively.
This case highlights the importance of recognizing CES in patients with isolated urinary dysfunction after lumbar surgery, even when typical neurological symptoms such as lower limb weakness or perineal sensory loss are absent. Early detection and prompt surgical intervention are critical, as delayed diagnosis may result in permanent neurological deficits. Moreover, this case underscores the need for vigilant postoperative monitoring, especially of urinary function, as isolated urinary symptoms may signal early CES. Maintaining a high index of suspicion for CES, even in atypical presentations, can facilitate timely diagnosis and improve patient outcomes. Furthermore, this case highlights the need for continued research into the prevention of SEH and the development of more robust diagnostic criteria for CES in postoperative patients. Future studies should focus on developing more comprehensive guidelines for monitoring postoperative patients, especially regarding urinary function, to aid in the early detection of CES.
术后脊髓硬膜外血肿（SEH）是腰椎手术后一种罕见但严重的并发症，马尾综合征（CES）是其最严重的后果之一。虽然CES通常表现为膀胱和/或肠道功能障碍、鞍区感觉减退以及下肢运动或感觉改变的综合症状，但仅有孤立性泌尿症状的非典型病例较少被认识，且带来重大的诊断挑战。
我们报告一例46岁男性患者，在腰椎显微椎间盘切除术后发生CES，仅表现为尿潴留，无下肢无力或会阴感觉丧失的典型体征。初始症状被归因于术后泌尿问题，从而延迟了CES的诊断。术后第7天，磁共振成像（MRI）显示有SEH，遂进行了紧急血肿清除术。尽管干预延迟，但患者神经功能完全恢复，术后3个月膀胱和肠道功能恢复。
该病例强调了在腰椎手术后出现孤立性泌尿功能障碍的患者中识别CES的重要性，即使没有下肢无力或会阴感觉丧失等典型神经症状。早期发现和及时手术干预至关重要，因为延迟诊断可能导致永久性神经功能缺损。此外，该病例强调了术后密切监测的必要性，尤其是对泌尿功能的监测，因为孤立性泌尿症状可能预示着早期CES。即使在非典型表现中，对CES保持高度怀疑指数有助于及时诊断并改善患者预后。此外，该病例突出了对预防SEH以及为术后患者制定更完善的CES诊断标准进行持续研究的必要性。未来的研究应侧重于制定更全面的术后患者监测指南，尤其是关于泌尿功能的指南，以帮助早期发现CES。
