Discogenic compression of the cauda equina: a surgical emergency

T A Dinning, H R Schaeffer
Australian and New Zealand Journal of Surgery 1993, 63 (12): 927-34
The syndrome of cauda equina compression due to central disc rupture is uncommon but its importance greatly transcends its rarity. Key symptoms and signs are bilateral leg pain, weakness or numbness (although unilateral symptoms or even absence of leg pain do not exclude the diagnosis), perineal numbness and, in 60% of patients, bladder and bowel incompetence ranging from dysuria to vesical and anal sphincter paralysis. Diagnosis and treatment are often delayed due to lack of recognition of the condition and failure to appreciate the surgical imperative for its treatment. At the present time myelography is the one essential investigation, although this may become supplanted in time by magnetic resonance imaging. Arrangements for myelography should be planned so that immediate operation can be commenced following the procedure. The onset of disc rupture may be acute and massive and result in intradural sequestration of disc fragments in 7.5% of cases. Intradural exploration and/or transdural sequestrectomy avoids traction on already compromised nerve roots and is often safer than extradural sequestrectomy. The onset of bladder paralysis is a most important indication for immediate surgery. The cases presented show that there is a highly significant difference in the outcome of those cases operated on within 24h of bladder paralysis compared to those operated on after this period.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.