title: Penetrating injury to the cauda equina: a case report and review of the literature.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report a rare case of a penetrating injury to the cauda equina, secondary to a stab wound.
  
  
  BACKGROUND
  Penetrating injuries affecting the cauda equina by stab wounds, not by gunshot wounds, are of extremely rare occurrence compared with penetrating spinal cord injuries and have been previously reported only in 2 studies since 1969.
  
  
  RESULTS
  A 43-year-old man was presented with a stab wound to the right lumbar region, with immediate paralysis of the left lower extremity accompanied by loss of perineal sensation. Magnetic resonance imaging suggested rupture of the cauda equina nerves at the L3 to L4 level. The patient was taken immediately for surgery for irrigation and debridement. We identified several cut ends of the cauda equina nerves and attempted to repair them, but had to determine that accurate matching of the severed ends would be problematic. At 2 years follow-up, there were no significant improvements in the neurological status. The patient was ambulatory with an ankle-foot orthosis, and had already returned back to work.
  
  
  CONCLUSIONS
  We could not repair the cauda equina rootlets. However, similar to other central nervous system penetrating injuries, the priorities of treatment included an emphasis on infection control and sealing of the duro-cutaneous fistula, and we could easily manage both by the emergency surgery. Although there were no improvements in the neurological function, there were no complications and the patient returned to a reasonably good function.
authors: Department of Orthopaedic Surgery, St Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, Japan. yumikami@luke.or.jp
authors: Yuji
authors: Y
authors: Mikami
authors: Atsushi
authors: A
authors: Tasaki
authors: Wataru
authors: W
authors: Morita
authors: Eishi
authors: E
authors: Kuroda
authors: Yoshimitsu
authors: Y
authors: Hoshikawa
mesh_terms: D000328:Adult; D002420:Cauda Equina / Q000000981:diagnostic imaging* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery*