Cauda Equina Syndrome Secondary to Massive L4–L5 Disc Herniation: A Case Report

Cauda Equina Syndrome (CES) is a very unusual and highly critical emergency in surgery, which is a result of the compression of nerve roots in the lumbar-spinal region and the thalamus, which could have irreversible neurological impairments in case it is not addressed in due time. The following is an example of a 49-year-old healthy female who presented to the emergency department due to a 1-year history of axial lower back pain that occurred suddenly and spread to include bilateral lower-limb pain, paresthesia, and numbness. Remarkably, the patient has mentioned the recent development of involuntary micturition and defecation, which are the characteristics of autonomic dysfunction. Examination showed severe lower-extremity motor weakness (4/5 strength) and a severely poor straight-leg raise (0-20°). Stenosis was observed at the L4-L5 segmental canal on magnetic resonance imaging. The patient was stabilized and was given intravenous corticosteroids and neuroprotective factors until the definitive neurosurgical operation. This report highlights the urgency of the early detection of the so-called red-flag symptoms (in particular, bowel and urinary dysfunction) in patients with recurrent low back pain, and, hence, allowing timely decompression and avoids the occurrence of fatal paralysis.