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Hemi-Cauda Equina Syndrome from Herniated Lumbar Disc: a Neurosurgical Emergency?

Published online by Cambridge University Press:  18 September 2015

Ronald H.M.A. Bartels  and
Joost de Vries
Ronald H.M.A. Bartels*
Affiliation:
Department of Neurosurgery, University Hospital Nijmegen, Nijmegen, The Netherlands
Joost de Vries
Affiliation:
Department of Neurosurgery, University Hospital Nijmegen, Nijmegen, The Netherlands
*
University Hospital Nijmegen, Department of Neurosurgery, R. Postlaan 4, 6500 HB Nijmegen, The Netherlands
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Abstract

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Background: We report experience with patients presenting with a specific combination of symptoms: unilateral sciatica, unilateral sensibility loss in the dermatomes SI to S5 (hemi-saddle) and subjective micturation problems secondary to ruptured lumbar disc. Because of its similarities with a cauda equina syndrome, this combination of symptoms was thought to be a unilateral cauda equina syndrome and it was called hemi-cauda equina syndrome. Consequently, it was treated as an emergency. Methods: Ten patients were evaluated. They compromised 2.3% of all patients undergoing lumbar discectomy. Results: Outcome is good with only 10% persisting minor neurologic deficit (sensibility loss in dermatomes S3 to S5). With the exception of urinary retention or incontinence, duration of symptoms and signs does not seem to influence outcome. Comparing signs, symptoms and radiographic findings with those of a cauda equina syndrome which were recently and thoroughly studied, they were found to be more severe in cases of cauda equina syndrome. Especially, the good outcome, (apparently unrelated to the duration of symptoms in cases of hemi-cauda equina syndrome) contrasted with the treatment results of cauda equina syndrome. Conclusions: We defined the hemi-cauda equina syndrome from ruptured disc as a combination of unilateral leg pain, unilateral sensibility loss in dermatomes SI to S5 and sphincter paralysis (proven urinary retention or incontinence). Motor deficit is not necessarily present. Emergency surgery is warranted. Patients presenting with micturation complaints other than urinary retention or incontinence do not suffer from a hemi-cauda equina syndrome.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 23 , Issue 4 , November 1996 , pp. 296 - 299
Copyright
Copyright © Canadian Neurological Sciences Federation 1996

References

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