ABSTRACT
Los disrafismos espinales cerrados tienen una prevalencia aún desconocida e involucran una gran variedad de formas. El lipoma del filum terminal es considerado dentro de los lipomas espinales y suele asociarse a médula anclada. Los estigmas cutáneos lumbosacros no siempre son indicadores de disrafismo espinal cerrado. Reportamos un caso de diagnóstico prenatal de apéndice cutáneo sacro con sospecha de médula anclada, confirmado al nacer como lipoma del filum terminal con médula anclada.
Closed spinal dysraphisms have a still unknown prevalence and involve a wide variety of forms. Lipoma of the filum terminale is considered within spinal lipomas and is usually associated with tethered medulla. Lumbosacral cutaneous stigmata are not always indicative of closed spinal dysraphism. We report a case of prenatal diagnosis of sacral cutaneous appendage with suspected tethered cord, confirmed at birth as lipoma of the filum terminale with tethered cord.
ABSTRACT
Spinal cord stimulation (SCS) consists of the application of electrical stimuli to the dorsal columns of the spinal cord or to the posterior nerve roots in order to modulate the pain signals carried by the ascending pain pathways to the brain. Two cases of SCS in patients with cauda equina syndrome after lumbar surgery are presented. They were treated for persistent neuropathic pain but also experienced improvement in their motor and urinary symptoms after this treatment. Although the primary indication for SCS is neuropathic pain control, its application can also lead to improvement of motor deficits, sensory disorders, and urinary incontinence, as shown in these two cases. SCS will likely play a fundamental role in rehabilitative therapies in different neurological diseases. Further investigation in the field is needed (AU)
La estimulación medular (SCS) consiste en la aplicación de estímulos eléctricos a las columnas dorsales de la médula espinal o a las raíces nerviosas para modular las señales de dolor en su vía ascendente hacia el cerebro. Se presentan dos casos del síndrome de cauda equina, secundario a cirugías lumbares. Estos fueron tratados por dolor neuropático persistente, pero también experimentaron mejoría de sus síntomas motores y urológicos con la SCS. La principal indicación de la SCS es el control del dolor neuropático; sin embargo, su uso también podría mejorar déficits neurológicos, alteraciones de la sensibilidad y la incontinencia urinaria, como se muestra en estos dos casos. La SCS probablemente jugará un rol importante en las terapias rehabilitadoras en algunas enfermedades neurológicas, aunque se necesita más investigación en este campo para estudiar dichos efectos (AU)
Subject(s)
Humans , Female , Young Adult , Adult , Cauda Equina Syndrome/therapy , Spinal Cord Stimulation/methods , Cauda Equina Syndrome/etiology , Treatment OutcomeABSTRACT
Spinal cord stimulation (SCS) consists of the application of electrical stimuli to the dorsal columns of the spinal cord or to the posterior nerve roots in order to modulate the pain signals carried by the ascending pain pathways to the brain. Two cases of SCS in patients with cauda equina syndrome after lumbar surgery are presented. They were treated for persistent neuropathic pain but also experienced improvement in their motor and urinary symptoms after this treatment. Although the primary indication for SCS is neuropathic pain control, its application can also lead to improvement of motor deficits, sensory disorders, and urinary incontinence, as shown in these two cases. SCS will likely play a fundamental role in rehabilitative therapies in different neurological diseases. Further investigation in the field is needed.
Subject(s)
Cauda Equina Syndrome , Cauda Equina , Spinal Cord Stimulation , Cauda Equina Syndrome/etiology , Cauda Equina Syndrome/therapy , Humans , Spinal Cord , Spinal Nerve RootsABSTRACT
Spinal cord stimulation (SCS) consists of the application of electrical stimuli to the dorsal columns of the spinal cord or to the posterior nerve roots in order to modulate the pain signals carried by the ascending pain pathways to the brain. Two cases of SCS in patients with cauda equina syndrome after lumbar surgery are presented. They were treated for persistent neuropathic pain but also experienced improvement in their motor and urinary symptoms after this treatment. Although the primary indication for SCS is neuropathic pain control, its application can also lead to improvement of motor deficits, sensory disorders, and urinary incontinence, as shown in these two cases. SCS will likely play a fundamental role in rehabilitative therapies in different neurological diseases. Further investigation in the field is needed.
ABSTRACT
RESUMEN: El uso de la anestesia regional se ha expandido en las últimas tres décadas, cada vez son más los profesionales que optan por esta técnica frente a la administración de anestesia general. La incidencia del síndrome de cauda equina SCE se reporta aproximadamente de 1 paciente en 32000. Se describe el caso de una paciente que presenta esta complicación, su tratamiento y evolución.
ABSTRACT: The use of regional anesthesia has expanded over the last three decades, more and more professionals opting for this technique versus the administration of general anesthesia. The incidence of SCE equine tail syndrome is reported in approximately 1 patient in 32000. The case of a patient presenting this complication, its treatment and evolution is described.
RESUMO: O uso da anestesia regional se expandiu nos últimos tres débitos, cada vez mais filho e os profesionales que optan por esta técnica frente a administração de anestesia geral. A incidencia da síndrome da cauda equina SCE se reporta a aproximadamente 1 paciente em 32000. Se descreve o caso de uma paciente que esta complicada, su tratamiento y evolución.
ABSTRACT
Low back pain during pregnancy is a common cause of medical consultation. Although back pain is very common, the incidence of low back pain secondary to lumbar disk herniation in pregnancy is low (1: 10,000). Cauda equina syndrome from lumbar disk herniation is a serious complication. The delay in diagnosis and treatment can be a cause of chronic disability secondary to neurological sequelae. Numerous cases of disk herniation in pregnancy have been reported, however the association of a cauda equina syndrome as a result of disk herniation is rare. A case is presented of cauda equina syndrome in a pregnant woman at 12-week gestation.
Subject(s)
Intervertebral Disc Displacement/diagnosis , Low Back Pain/etiology , Lumbar Vertebrae , Polyradiculopathy/etiology , Pregnancy Complications/diagnosis , Adult , Female , Humans , Intervertebral Disc Displacement/complications , Polyradiculopathy/diagnosis , Pregnancy , Pregnancy Complications/etiologyABSTRACT
OBJECTIVE: To determine whether surgical treatment delayed for more than 48 hours in patients with cauda equina syndrome (CES) influenced the clinical outcome. MATERIAL AND METHODS: A retrospective study of 18 patients treated in our hospital from March 2000 to January 2012, after presenting with CES. The pre- and post-operative clinical status was determined: existence of back pain and/or sciatica, sensory disturbance in the perineum, sensory and motor deficits in the lower extremities, and the degree of sphincter incontinence (complete or incomplete CES). A clinical assessment was performed using the Oswestry disability index. RESULTS: As regards the onset of symptoms, 44% (8 of 18) of patients were treated at an early stage (within 48 hours). None of the patients with complete CES operated in the early stage had urinary incontinence, and also had greater motor recovery. Of the 5 patients with complete CES who underwent delayed surgery, 3 showed residual urinary incontinence. A mean of 12.55 was obtained on the Oswestry disability index scale at the end of follow-up. CONCLUSION: Although no statistically significant difference was found in our study, we observed greater motor and sphincter recovery in patients who were operated on within 48 hours.