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  4. Against the odds: extraordinary recovery from complete cauda equina syndrome following L3 fracture. Time still matters

Against the odds: extraordinary recovery from complete cauda equina syndrome following L3 fracture. Time still matters

Spinal Cord Series and Cases, 2016 · DOI: 10.1038/scsandc.2016.27 · Published: November 10, 2016

Spinal Cord InjurySurgery

Simple Explanation

Cauda Equina Syndrome (CES) happens when the bundle of nerves at the bottom of the spinal cord is damaged. This can cause problems with moving and feeling in the legs, as well as bladder and bowel control. This case study reports on a 24-year-old who suffered a complete CES due to a broken bone in his lower back (L3 fracture) from a road accident. He was unable to move his legs or control his bladder or bowels. The patient had surgery within 12 hours of the accident to fix the fracture and relieve pressure on the nerves. Surprisingly, he made a full recovery and regained normal function.

Study Duration
2 years
Participants
1 patient: a 24-year-old male
Evidence Level
Level 4: Case Report

Key Findings

  • 1
    A patient with complete cauda equina syndrome (AIS A) due to an L3 fracture recovered to full neurological function (AIS E) after early surgical intervention.
  • 2
    Early surgical decompression (within 12 hours) may lead to exceptionally good outcomes even in complete cauda equina injuries.
  • 3
    The case supports the argument for early surgery in complete injuries.

Research Summary

This case report describes a 24-year-old patient who experienced complete cauda equina syndrome (CES) following an L3 vertebral body fracture due to a road traffic collision. The patient underwent early surgical intervention within 12 hours of the injury, involving posterior fusion and decompression from L3 to L5. Remarkably, the patient recovered from complete loss of motor and sensory function (AIS A) to full neurological function (AIS E) and was able to return to normal activities.

Practical Implications

Early Surgical Intervention

This case suggests that early surgical intervention should be considered even in cases of complete CES, as it may lead to unexpectedly positive outcomes.

Time Sensitivity

Highlights the potential importance of timely surgical decompression in traumatic CES to maximize the chances of neurological recovery.

Rehabilitation

Emphasizes the role of specialist neurorehabilitation in facilitating functional recovery after surgical intervention for CES.

Study Limitations

  • 1
    Single case report limits generalizability.
  • 2
    Lack of MRI may have affected diagnostic precision.
  • 3
    Unknown factors contributing to the exceptional recovery.

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