Cauda Equina Syndrome
The question is often asked: When is back pain an emergency?
Diane had suffered back pain off and on for 6 months before that emergency moment arrived. And when it did, she knew. She had severe pain. She couldn't feel her right leg. Awakened in the night and alarmed by her condition, Diane struggled to reach her phone. After what felt like hours, she finally was able to call her nephew, Terry, for help. By the time he reached her, she could hardly walk.
Terry didn't leave her side until paramedics arrived. Nor did Diane's dog, Oscar, who licked her paralyzed leg in an attempt to comfort her.
When Diane arrived at Bethesda North Hospital, she was in severe pain and completely unable to void. She had experienced some difficulty with voiding in the weeks preceding her admission, and a bladder stimulator had been surgically implanted.
Dale Horne, MD, PhD, a neurosurgeon with Mayfield Brain & Spine, was called to assess her severe spinal pain. Suspecting that her problems with voiding were related to her spine, he had her bladder stimulator removed so that he could obtain an emergency MRI. The MRI showed a large herniated disc at L5-S1, which was causing Diane's back, leg, and urinary symptoms.
"Technically, this condition is known as cauda equina syndrome," Dr. Horne says. "It can occur when an unusually large disc herniation in the lumbar spine presses on the nerve roots at the end of the spinal cord. These nerves are important because they send messages to and from the bladder, bowel, and legs. If the condition is not treated promptly, permanent damage can occur."
"When Dr. Horne came in to see me, I was in so much pain," Diane recalls. "I had severe pain in my back, and I didn't have any feeling in my right leg."
Dr. Horne did not delay. He scheduled Diane for emergency surgery, and he relieved pressure on the nerve roots with a minimally invasive approach, using a tube retractor and microscope to remove the offending disc material.
For Diane, relief came almost immediately. "When I was in the recovery room, Dr. Horne came in to see me," Diane recalls. "I could feel that my leg was no longer paralyzed. It was miraculous. I could wiggle my toes, and I recognized that right away. I don't know who smiled the most, Dr. Horne or me. He was so sweet when he asked whether I could I move my leg."
Diane, a registered nurse who had undergone previous surgeries, continues to be amazed that a surgery with such a small incision could make such a big difference. "Because they didn't have to cut through a large field of tissue, I didn't have as much to repair, and the pain didn't drain me, take a lot out of me," she says. "It made a huge difference. When I had a knee replacement, I was in much more pain. With this smaller incision, there was also a smaller chance of infection."
Diane expressed her appreciation before she left the hospital by giving Dr. Horne "the biggest hug," because of the difference he had made in her life. Says Diane: "I credit him with allowing me to walk on the beach again with my grandchildren."
~ Cindy Starr
Hope Story Disclaimer -"Diane's Story" is about one patient's health-care experience. Please bear in mind that because every patient is unique, individual patients may respond to treatment in different ways. Results are influenced by many factors and may vary from patient to patient.
"I credit him (Dr. Horne) with allowing me to walk on the beach again with my grandchildren."