Abstract
Abstract A 72-year-old male with past medical history of common chronic illness presented to a rehabilitation clinic with a chief complaint of trouble walking and falls over 6 months. On detailed questioning, he has developed progressive bladder incontinence and unable to achieve erection. Physical exam revealed normal rectal tone and minimal bladder retention. Lumbar spine MRI shows severe spinal canal stenosis, with posterior elements impinging on the Conus Medullaris. He underwent T9-11 laminectomy. Upon follow up nearly 2-years post-operation, he is continent of bladder and able to walk with a rolling walker. The main differential diagnosis was Cauda Equina syndrome. Although both syndromes are surgical emergencies, accurate diagnosis would affect the surgical approach and outcome.
Highlights
A 72-year-old male with past medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and depression
An MRI scan of the lumbar spine reported various diffuse disc bulges and ligamentum flavum thickening at L2-5 levels, with severe bilateral L5 neuroforaminal narrowing
On the T1 weighted image, posterior elements, including the ligamentum flavum (Figure 1B, yellow arrow) were visible, with the adjacent spinal cord compressed to a thin layer
Summary
The patient was 5’8, with a weight of 150 lbs. At the Emergency Department, he was found to have weakness of hip flexors and extensors. He had normal rectal tone, voided 400 ml of urine on his own and had a residual volume of 42 ml as measured by ultrasound bladder scan. He had intact perianal sensation, and “normal” patellar tendon reflex
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