Successful surgical emergency of cauda equina syndrome
That was how an emergency physician recounted a report he had received from an EMS crew upon arrival to City International Hospital. the doctor continued. "Essentially, his wife and family called emergency because the man was so weak that they had to help him stand, and he could not move his legs.
source: infonet.com
The patient care report (PCR) for this call indicated that the patient was a 31-year-old man with no apparent chronic medical problems. He was found lying on his bedroom floor with the wife nearby. The patient advised EMS that he had developed significant back pain within the past month without any history of trauma. The pain had increased and eventually become nearly intolerable.
The man had sought care at other the local pharmacies and was given narcotic pain medications and muscle relaxants. But they had not helped. The wife and other family members had requested EMS because the pain was so bad, the man could not walk.
When the patient arrived at the ED .0 a.m. March 2, 2019, the emergency physician obtained a similar story as the prehospital personnel had documented but got much more detail. The patient developed back pain for no reason and took medications from the local retailed pharmacies. The wife noted subsequently that her husband was walking with an "old man" type of gait. His legs became weaker, and he started noticing numbness and tingling in the toes of both feet.The physical examination by the emergency physician revealed diffuse tenderness in the lumbar region of the back. The patient had difficulty rolling over and had to be assisted. The patient was unable to lift his legs and was unable to flex his hips. The strength in his legs was rated at two out of five. The deep tendon reflexes were markedly decreased in both legs.
Then Dr. Huynh Hong Chau, Head of Neurosurgery Department of City International Hospital's initial concern was that the patient might have an acutely herniated disk with resultant Cauda Equina Syndrome (CES) - a condition in which there's acute compression on the nerve. At that point the doctor considered rapid recognition combined with prompt neurosurgical intervention provides the best opportunity for recovery.
Everyone agrees that prompt diagnosis of CES critical. CES require an emergency MRI to confirm the diagnosis. If the diagnosis is confirmed, the standard of care usually required decompression which removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. Consecutive MR neurography lumbosacral plexus examination at CIH were reviewed retrospectively, to evaluate the lumbosacral spine of patients suspected of having subacute or chronic cauda equina syndrome. the patient with a disc herniated Severe L4/5 lumbar spinal stenosis causing Cauda Equina Syndrome - the center of the left side, the previous size is about 16mm , dural compression, strong compression of the horse-tail nerve roots at the same level.Later multidisciplinary team meeting reassessed the data clearly shows that the patient’s acute CES is a true emergency, the most prudent path is immediate decompressive surgery within 24 hours to salvage all nerves to prevent irreversible damages & incomplete recovery
Disc Herniations Of the Lumbar Spine Shown On Color Mri L4/5 Disc
the next day, a minimally invasive surgery was performed by Dr. Huynh Hong Chau …..via a 2 cm mini- wound….under microscope…. all your cauda equina nerves were salvaged… once U wake up from anesthesia… you can tell your husband & daughter that your legs have more strength…all numb & pain were disappeared. The procedure lasted for two hours and the patient N.T.V, is recovering well.I experienced only three to four weeks of back pain without any trauma, and it occurred out of the blue. So, this isn't chronic pain; it's really acute back pain. Patient shared. "Two days prior to transport,my left leg "gave out," and he fell I fell couple more times that day. Ultimately, I had been crawling on the floor for hours before EMS was called. The pain was s dull and aching and having spread out from the center of the back to both sides. I'm so thankful for all the excellent help from my doctors and all staff of CIH."
City International Hospital is one of the first few hospitals applied high-tech surgical technique for a lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates.
Dr. Huynh Hong Chauis the most senior surgeon, clinical instructor, senior consultant neurosurgeon with 37 years of experience in neurosurgery. He is the medical director of Neurosurgery Division at HCMC University Medical Center, and currently practices in City International Hospital, Vietnam. His various areas of expertise include: combined Neurosurgery and spine surgery , neurovascular diseases of the brain, carotid artery disease, skull base surgery for complex intracranial tumors, peripheral nerves surgery, trigeminal neuralgia, and hydrocephalus.
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