Cauda Equina Syndrome Following Lumbar Disc Herniation at L5-S1: A Case Report

Objective

The purpose of this article is to describe a patient presenting to a chiropractic clinic with rapidly progressing cauda equina symptoms.

Clinical Features

A 30-year-old woman presented to a chiropractic clinic with the onset of saddle distribution sensory loss and urinary retention. The patient had worsening symptoms 48 hours following evaluation at local emergency and radiology departments.

Intervention and Outcomes

After a brief history and evaluation, the patient was immediately referred back to the emergency department. Based on the rapidly progressive clinical presentation and previous magnetic resonance study of the lumbar spine, immediate decompressive surgery was performed the same day. Low back pain and neurogenic symptoms persisted following surgery, and that prompted a trial of epidural injections and pelvic floor therapy with minimal relief. One year later, the patient returned with back pain for chiropractic treatment to include cupping, cold laser therapy, Cox flexion-distraction, and McKenzie-based at-home exercises for post-laminectomy syndrome. Chiropractic treatment provided a mild decrease in symptoms and severity over the course of 3 months.

Conclusion

This case demonstrates that chiropractic physicians should be aware of the clinical manifestations and possible rapid progression of cauda equina symptoms to avoid a delay in diagnosis. The patient responded well to postoperative chiropractic care.