Acute postoperative cauda equina syndrome following an elective gynecological procedure

Abstract

We report a patient with cauda equina syndrome who presented immediately following hysterectomy. Intraoperative cauda equina syndrome is very rare, and to our knowledge, this is the first case reported following a gynecological procedure, which was unequivocally caused by a herniated intervertebral disc. A 72-year-old woman with a history of chronic low back pain and degenerative disc disease was referred to the orthopedic service after developing urinary retention, decreased rectal tone, and diminished bilateral lower extremity sensory and motor function following hysterectomy for the management of endometrial carcinoma. Magnetic resonance imaging revealed a large central disc herniation at L2/3. Due to a delay in recognition of the progressive neurological deterioration that began immediately postoperatively, decompressive surgery was performed between 48 and 72 hours after the onset of symptoms. Emergent surgical decompression including laminectomy and microdiscectomy resulted in improved bowel and urinary function but no improvement in lower extremity strength or sensation. Cauda equina syndrome is a rare but devastating condition whose recognition and management requires vigilance, communication, and early surgical involvement. This case presents novel information that cauda equina syndrome can occur immediately postoperatively from disc prolapse during unrelated procedures.