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Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. [2] Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. [1]
Intradural disc herniation occurs when the disc material crosses the dura mater and enters the thecal sac. It is a rare form of disc herniation with an incidence of 0.2–2.2%. Pre-operative imaging can be helpful for diagnosis, but intra-operative findings are required for confirmation. [26]
Other symptoms include impaired walking and a slightly stooped posture due to loss of disc height and bulging of the disc. Lumbar spinal stenosis is very prevalent with 9.3% of the general population producing symptoms and the number is continuing to rise in patients older than 60. [ 16 ]
Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called herniorrhaphy). If complications have occurred, the surgeon will check the viability of the herniated organ and remove part of it if necessary. da Vinci Surgical System
Imaging can assist in excluding other conditions with similar symptoms, such as lumbar disc herniation and spinal stenosis. [29] Diagnostic injections of anesthetic into the piriformis may be used to confirm the diagnosis. [29] Often piriformis syndrome is a diagnosis of exclusion. [29]
Surgery may be useful in those with a herniated disc that is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control. [17] It may also be useful in those with spinal stenosis. [18] In the absence of these issues, there is no clear evidence of a benefit from surgery. [17]
As a mechanical source, spinal and cranial surgery, [7] trauma, [8] and disc herniation. [8] Prior disease including ankylosing spondylitis, [ 5 ] [ 9 ] autoimmune vasculitis, [ 2 ] and Guillain-Barré syndrome [ 2 ] have been known to cause arachnoiditis.
CT scan image of large herniated disc in the lumbar spine. Removal of a disc at one level can lead to disc herniation at a different level at a later time. Even the most complete surgical excision of the disc still leaves 30–40% of the disc, which cannot be safely removed. This retained disc can re-herniate sometime after surgery.