Intraoperative Injury to the Cauda Equina and Nerve Roots

Abstract

Lumbar surgery is common and in most cases quite safe. Injuries to the cauda equina and nerve roots are an inherent risk, but based on current literature this appears to be relatively uncommon. Nerve roots may be injured in isolation, but cauda equina injuries may be attended by dural injuries. The literature on incidental durotomy indicates that dural disruption occurs relatively frequently (3.5-14% of cases) but can be successfully managed with a low risk of adverse sequelae (1-3). None of these cited studies report associated neurological deficit. If the cauda equina is manipulated during a dural repair, transient neural dysfunction may occur. If dural laceration is attended by root transection, the prognosis would depend on the extent of neural disruption. Combined dural and cauda equina injuries could occur with both manual and power instruments. Misplaced pedicle screws and other types of instrumentation could injure the dura and nerve roots. Cauda equina injury by pedicle screws can occur but is not common in the hands of an experienced spine surgeon unless the anatomy is quite distorted.