The Journal of Bone and Joint Surgery, Vol 72, Issue 3 369-377, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Cauda equina syndrome after in situ arthrodesis for severe spondylolisthesis at the lumbosacral junction
PL Schoenecker, HO Cole, JA Herring, AM Capelli and DS Bradford
Shriners Hospitals for Crippled Children, St. Louis, Missouri 63131-3597.
Relative stretching of the cauda equina over the posterosuperior border of
the sacrum can be found in all patients who have Grade-III or IV
spondylolisthesis at the lumbosacral junction. We identified twelve
patients, all less than eighteen years old, who had cauda equina syndrome
after in situ arthrodesis for Grade-III or IV lumbosacral
spondylolisthesis. In all twelve patients, posterolateral arthrodesis had
been done bilaterally through a midline or paraspinal muscle-splitting
approach. Nothing in the operative reports suggested that the cauda equina
had been directly injured during any of the procedures. Five of the twelve
patients eventually recovered completely. The remaining seven patients had
a permanent residual neurological deficit, manifested by complete or
partial inability to control the bowel and bladder. If dysfunction of the
root of the sacral nerve is noted preoperatively in a patient who has
lumbosacral spondylolisthesis, decompression of the cauda equina
concomitant with the arthrodesis should be considered. An acute cauda
equina syndrome that follows a seemingly uneventful in situ arthrodesis for
spondylolisthesis is best treated by an immediate decompression that
includes resection of the posterosuperior rim of the dome of the sacrum and
the adjacent intervertebral disc. In addition, posterior insertion of
instrumentation and reduction of the lumbosacral spondylolisthesis should
be considered.
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