Extended posture of lumbar spine precipitating cauda equina compression arising from a postoperative epidural clot.
We report a patient with nonoperatively treated acute cauda equina compression arising from an epidural clot that developed after decompressive surgery for lumbar canal stenosis. A 43-year-old woman underwent lumbar laminotomy, and was symptom-free for 3 hours; but this was followed by paresis. Postoperative myelography showed obstruction of the contrast column at the level of the laminotomy; this was relieved by hyperflexion of the lumbar spine. With sustained hyperflexion of the lumbar spine, all neurologic deficits were completely resolved within 5 days. Lumbar lordosis may be present when a patient lies in the supine position on a flat bed with the hips and knees extended; this may exacerbate dural constriction caused by an epidural clot following posterior lumbar spinal surgery.
Ko
Y
Y
Department of Orthopaedic Surgery, Osaka Police Hospital, Japan.
Kakiuchi
M
M
D000328:Adult; D002420:Cauda Equina; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000150:complications*; D006801:Humans; D007796:Laminectomy; D008141:Lordosis / Q000150:complications; D008159:Lumbar Vertebrae / Q000601:surgery; D009192:Myelography; D011183:Postoperative Complications; D011187:Posture; D013117:Spinal Cord Compression / Q000209:etiology* / Q000503:physiopathology*; D013130:Spinal Stenosis / Q000601:surgery