Pseudo cauda equina from anesthesia?

Tagged: Cauda equina syndrome after an endoscopic microdisectomy

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anna
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November 24, 2019 at 3:09 pm

Post count: 15

#31533

Dr C,
I had an endoscopic microdisectomy on my L5 four weeks ago that seemed successful with the exception of some nerve inflammation. However, I woke up from the surgery unable to feel my entire buttocks and saddle seat area, right leg weakness, slight right foot drop and uncooperative right toes. Problem is I did not have any of these symptoms before the surgery. My radiculopathy was on my left side. My neurosurgeon says he did no work on my right side and everything should return to normal in a month. I’m relieved to report most of it has…although I still have a small area in the lower central part of my buttocks that is numb and my right leg (calf?) is still weak so my gait lurches a little when I walk.

Could this be due to the extra local anesthesia I received? I was under anesthesia twice as expected because a hair was found on the surgical equipment so my surgery had to be delayed until everything was decontaminated. Unfortunately I had already been put under before the hair was found. According to my anesthesiologists report I received a total of Lidocaine 240, Rocuronium 30 and Neostigmine 3.

Thank you thank you thank you!

Donald Corenman, MD, DC
Moderator

November 28, 2019 at 5:45 am

Post count: 8660

#31553

You sound like you had a temporary cauda equina syndrome. Did you have a spinal anesthesia (fluids directly injected into your spinal canal) or were you under general anesthesia?

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

anna
Participant

November 28, 2019 at 10:53 am

Post count: 15

#31559

Sir,
In reviewing the anesthesiologists notes it appears I only received general anesthesia by IV. As I mention above the total lidocaine was 240mg which seems like a lot. It’s unbelievable to me that at 5 weeks my saddle seat area STILL feels heavy/dead/numb! I’ve been walking and doing gentle physical therapy in the hopes it will help. Is there anything more I can do other than wait? Like oral steroids (please reference my other forum question)? Could this end up a permanent condition?

Thank you for being there for us back patients around the world who are struggling to make sense of their symptoms.

Donald Corenman, MD, DC
Moderator

November 29, 2019 at 3:41 am

Post count: 8660

#31574

If you only had an IV without a tube in your throat, you did not have a general anesthetic. You had IV sedation. Did the surgeon inject fluid into your spine (an epidural or intradural injection)?

If anesthetic fluid was injected into the spinal canal, the shear volume of 240mg of lidocaine can cause a mass effect which could explain your cauda equina injury. The other possibility is that the endoscope could have causes a compression phenomenon.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

anna
Participant

November 29, 2019 at 8:52 am

Post count: 15

#31584

Dr C,
I tried calling the anesthesiologist, but they are closed today so I referred to their notes which are difficult to decipher due to their messy handwriting. They did not check the boxes on their form for “Spinal” or “Epidural” etc. Instead, they checked the boxes for “General”, “PreO2”, “IV”, “BBS” and “etCO2”. I know I also had a tube down my throat in addition to the IV so I believe I had general anesthesia.

I told my neurosurgeon of my saddle seat numbness and right leg weakness the day after the surgery and he shrugged them off and said it would take a month or so to wear off. When I informed his nurse at the 4 week mark that I still felt numb/heavy in my buttocks she said that was normal. No steroids were ever offered me.

Additionally, I was kept overnight in the hospital because I could not void my bladder after my endoscopic microD. Looking back I realize this might have been another sign of cauda equina, but it was NOT treated as such by my doctor or his nurse. Fortunately, my bladder started working again 20 hours after the surgery and is almost back to normal. My bowel movements are also okay. I am uncomfortable sitting on anything other than a toilet because my backside feels so heavy and dead when I sit in a chair.

If this additional info sparks further insight I would greatly appreciate hearing your thoughts. I am puzzled and feel somewhat let down by my neurosurgeon. If I have to have another surgery down the road I know I am coming out to Vail to you! Hopefully you have no plans to retire. :)

Donald Corenman, MD, DC
Moderator

November 29, 2019 at 6:04 pm

Post count: 8660

#31594

You did have a general anesthesia if you had a tube down your throat. That would make it harder to understand why you developed a cauda equina syndrome if there was no fluid wave from a spinal anesthesia. Somehow, the procedure itself caused a compression of the cauda equina nerves in the canal and damaged the bowel and bladder nerves (Nervi erigantes). Thank goodness you are recovering from the worst affects.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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