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History :
Cauda Equina involvement was suspected in a 50-year-old man who visited Dr. Sangram Rajale in Pune for spine pain treatment. He had been experiencing lumbar pain for the past 15 days. A day later, the pain started radiating down his left leg. This raised immediate concerns about possible Cauda Equina compression.
Twenty days earlier, the patient had undergone an incision and drainage procedure for an infected abscess on his right thigh. The procedure was performed under spinal anesthesia. Following the surgery, he developed paralysis in both legs. This left him bedridden and caused difficulty in urination, which eventually led to severe stomach pain.
Due to the seriousness of his symptoms, urgent evaluation was needed to confirm Cauda Equina involvement. The patient also required focused lumbar pain treatment. This was essential to avoid further complications and support a successful recovery.
Symptoms Linked to Cauda Equina and Lumbar Pain
Along with lumbar pain and paralysis, the patient also reported recurring leg pain, numbness, and tingling. These symptoms may have resulted from years of heavy lifting, such as moving gas cylinders. His lower back pain disrupted sleep, and he had been running a fever for the past three days. This fever could be related to an underlying infection.
Urgent Cauda Equina Treatment to Prevent Further Damage
The patient showed signs of Cauda Equina Syndrome—lumbar pain, leg pain, numbness, and bladder issues. These symptoms indicated spinal nerve compression. Immediate Cauda Equina treatment was critical to prevent lasting nerve damage. His recent surgery and risk of infection made early diagnosis and focused care essential. Dr. Rajale prioritized timely intervention to stop further decline and promote recovery.
Spine Examination: Identifying Signs of Cauda Equina
During the examination, the patient had paraspinal muscle spasms and swelling at the L3-L4 level. Tenderness was also noted on the left side. The Straight Leg Raise (SLR) test was painful and restricted on the left. Basic movements like turning in bed or standing increased the back pain.
Muscle strength was reduced. His left knee and hip showed strength of about 4/5. Ankle dorsiflexion and plantarflexion were limited to 2/5. The Extensor Hallucis Longus (EHL) and Extensor Digitorum Longus (EDL) were also weak, both around 2/5.
Targeted Cauda Equina Treatment Plan
Dr. Rajale initiated a targeted Cauda Equina treatment plan. The goal was to manage lumbar pain, treat nerve compression, and support full neurological recovery. Early action was vital to improve outcomes and prevent long-term damage.
MRI :
A well-defined epidural collection was observed at the L3/4 level, resulting in severe narrowing of the Spinal cord. There is also edema visible in the paraspinal soft tissues, and the spinous process appears to be affected. These findings suggest an infectious etiology.
Operation :
On October 1, 2023, the patient underwent a L3-L4 laminectomy and decompression, along with debridement and posterior spinal fixation using Jayon implants. The procedure was performed by Top Spine Specialist in Pune Dr. Sangram Rajale under general anesthesia. A biopsy and pus culture were taken, revealing Methicillin-sensitive Staphylococcus aureus infection. Consequently, treatment with intravenous Cloxacillin 2gm every 4 hours was initiated and continued for 6 weeks.
Condition On Discharge :
Before surgery, the patient had moderate strength in his hip and knee muscles (rated 4/5), while his ankle muscles had weaker strength (rated 3/5). his foot muscles (EHL and EDL) were also weak, rated at 2/5. After surgery, the patient showed improvement in ankle strength, with dorsiflexion and plantarflexion now rated at 5/5. The extensor muscles in the foot (EHL and EDL) also improved to 4/5.
Overall, there was significant enhancement in strength postoperatively, especially in the ankle and foot muscles.