Cauda Equina Syndrome Summary

On examination, cervical and lumbar spine is restricted in all planes with increased pain. Muscle guarding is also noted. The patient is not able to heel and toe walk. He is obese and deconditioned. Straight leg raise (SLR) is positive bilaterally. Muscle guarding is noted along cervical paraspinal and trapezius muscle groups bilaterally. Sensation is normal to light touch, pinprick, and temperature along all dermatomes of the bilateral upper extremities, except right C6-8, decreased to

Per the medical report dated 03/29/2016 by Dr. Waghmarae, the patient believes that her left buttock pain has increased over the last month. She describes her pain as aching, throbbing and stabbing. She rates her pain symptoms as 8/10. Pain is relieved by medication, heat, ice and use of a Transcutaneous Electrical Nerve Stimulator (TENS) unit, and is increased by movement and standing for long periods of time. She states that her bilateral legs have also increased in pain severity over the last month. She believes because she is doing a lot of standing and trying to clean up her house. She states that pain is increasing in her left buttock. She is not involved in physical therapy, chiropractic, massage therapy or acupuncture. Palpation of the lumbosacral spine reveals abnormalities along the bilateral facet joints. There is pain in her axial lower back in all planes of lumbar motion that is

Carey reported that she experienced occasional numbness of the upper extremities and that she would occasionally drop objects from both hands. Upon physical examination, Dr. Abiera noted that Ms. Carey’s range of motion of the cervical spine was decreased on flexion and tenderness on palpation of posterior cervical muscles with spasms and trigger points was present. In addition, Dr. Abiera noted that the range of motion of lumbar spine was within normal range, however there was still some tenderness on palpation of thoracic paraspinals muscles.

MRI of the cervical spine dated 08/17/16 showed at C3-4 and C4-5, there is mild posterior disc bulging.

11/13/14 MRI of the lumbar spine showed 4mm left paracentral and foraminal disc protrusion at L4-5, which mildly impinges upon the thecal sac and the proximal left L5 nerve root. The disc protrusion also moderately narrows the left foramen and lateral recess. There was also a 2mm posterior central disc protrusion at L5-S1. A 2mm disc bulge at L2-3 was seen. There was a mild degenerative facet and ligament flava hypertrophy at L4-5 and

The pain has been worsening over the left buttock area associated with tingling and numbness down to the left leg. Medical treatment to date notes physical therapy and Nonsteroidal Antiinflammatory Drugs (NSAIDs) with limited improvement. Medical history and review of system notes that the patient is significant for hypertension. Examination of the lumbar spine revealed slight loss of lumbar lordosis. On palpation, there is moderate-to-severe guarding with reproduction of deep myofascial pain on deep palpation, mostly on the left side. Pain level is 7/10 at the time of examination. Range of motion revealed forward flexion of 50 degrees, extension of 10 degrees, right lateral flexion of 20 degrees, and left lateral flexion of 20

Manifestations of cauda equina syndrome are asymmetric weakness in legs, severe radicular pain in the back, thighs or legs or loss of sensation in the saddle area and/or bladder or bowel or sexual dysfunction (Rigler et al, 1991). Most of the reports of cauda equina syndrome following spinal anesthesia have been associated with use of both microcatheters which are caudally positioned and hyperbaric highly concentrated local anesthetics (in particular, hyperbaric 5% lidocaine and less commonly tetracaine) (Horlocker et al, 1997). The most likely cause is mal-distribution of the local anesthetic, following a slow injection through a small end-hole catheter. Hyperbaric solutions of local anesthetics are not preferred in CSA and especially not hyperbaric Lidocaine (Gielen, 1999). In the present study, where macrocatheters and isobaric bupivacaine are used, there were no neurological sequelae (motor, sensory or autonomic dysfunction) in any of the patients. Thus, CSA when correctly used is a safe

Disc herniation between L3 and L4 vertebra causes compression of the L4 nerve root as it crosses the intervertebral disc before exiting the L4 intervertebral foramina. Numbness may be present over the anteromedial aspect of the leg. Weakness of tibialis anterior muscle may be present as evidenced by absence of heel walking. The quadriceps and hip adductor group, also may be weak and, in extended ruptures, atrophic.Reflex testing may reveal a diminished or absent patellar tendon reflex (L2, L3, and L4) or anterior tibial tendon reflex (L4). Sensory testing may show diminished sensations over the L4 dermatome, predominantly the medial leg and the autonomous zone being skin over medial malleolus.

The ROM was restricted, 50% of normal. The paraspinal muscle strength and tone was normal. The SLR was negative bilaterally. The exam of the left lower extremity was normal. The exam of the right lower extremity was normal except mild decreased strength in the right hip flexors. A reported MRI Lumbar Imaging on 07/01/15 showed multilevel degenerative changes; Previous L4 to sacrum fusion, evidence of herniated disc or significant central stenosis or foraminal stenosis. A reported MRI L Spine on 11/05/15 revealed herniated disc L2-3 with inferior extrusion impinging on the right L3 nerve root. Assessment: The patient has continuing symptoms of pain in the right lower extremity radiating down along the anterior thigh. This is consistent with the herniated disc at the L2-3 level on the right. He had previous surgery at the L2-3 level 3 years ago for his work-related

There is tenderness to palpation over the entire lumbar paravertebral region bilaterally, left greater than right. Deep tendon reflexes are 1 + and symmetrical at the patellar and 1+ to the left Achilles and absent right Achilles.

Pain/tenderness is noted at the thoraco-lumbar, lower thoracic/lumbar, upper/lower lumbar, lumbo-sacral and sacral. Moderate muscle spasms are demonstrated in the following areas: bilateral lumbar, bilateral sacroiliac, sacral, bilateral posterior pelvis/hip, and bilateral buttocks.

DOI: 8/1/2014. Patient is a 46-year-old female relationships manager who incurred injury to her back from a horse at a camp site. As per OMNI, she was initially diagnosed with lumbar strain, thoracic strain, contusion at the low back and muscle spasm.

The patient has clear sacroiliac sulcus tenderness with direct palpation. Pain is reproduced with provocative testing, most prominent with hip flexion/abduction while externally rotated. Patrick’s/Faber’s test, pelvic thrust test, Gaenslen’s test with the patient supine, and Sacral Compression/Yeoman’s test while prone are positive. Spasm is noted at the bilaterally. Strength is decreased at the left lower extremity. Sensation to pin is decreased at left L3, L4, L5, S1 and left T1.

Navicular syndrome, or navicular disease, is a hoof problem in horses. Navicular syndrome is a degenerating bone disease that causes lameness in the horse. It deteriorates the navicular bone as well as the surrounding tissues. Navicular generally occurs on the front feet and happens when horses are between the age of eight and twelve. Navicular can lead to significant and even disabling lameness (“Navicular Problems: Symptoms and Treatment).

MRI of the lumbar spine done on 07/09/15 revealed at L2-L3, there is a 2 mm right foramen disc protrusion with right neuroforaminal narrowing. At L3-L4, 3 mm disc bulge is noted with borderline right neuroforaminal narrowing. At L4-L5, 2 to 3 mm disc bulge is seen with central stenosis on bilateral neuroforaminal narrowing, left greater than right. At L5-S 1, 3 mm broad base disc bulge bilateral facet arthrosis is noted with bilateral neuroforaminal