A 63 year old male was referred to Aster Hospital’s Neurology Department for evaluation of ‘Painless urinary retention’. The patient was seen by a Urologist in another clinic for urinary retention and was catheterized a week back. Two failed attempts at removing the urinary catheter, prompted the doctor to seek Neurology reference.
On further inquiry into his symptoms, the patient stated that his problem started when he attempted to lift a water can, resulting in sharp pain in his back with mild difficulty in walking, followed by painless urinary retention, 2 days later. He also admitted to having erectile dysfunction since the problem started.
On examination his higher mental functions, cranial nerves and both upper limbs were normal. His straight leg raising test was restricted bilaterally at 50 degree, there was mild L5 S1 distribution weakness in the form of inability to walk on heels and toes. His anal sphincter tone was reduced and there was perianal paresthesia.
MRI Lumber spine revealed large intervertebral disc prolapse between L4 AND L5 levels compressing multiple roots. The patient was admitted to the hospital and started on intravenous methyl prednisolone and option of surgical decompression of lumber spine was discussed with patient. The patient underwent spinal decompression by Laminectomy and Discectomy at L4-L5 level by Dr. Vivek Kumar Mishra, Specialist Orthopedic Surgeon at Aster Clinic, International City.
Perioperative recovery was uneventful. Patient’s urinary catheter could be successfully removed 3 days later and there was no weakness in his legs as described earlier.
Cauda Equina syndrome is a classical triad of motor weakness in legs along with bladder and erectile dysfunction that should prompt a clinician for spine problem and timely treatment that can save the patient form significant morbidity.
Specialist Orthopaedic Surgeon