Lumbar Disc Herniation with Cauda Equina Syndrome after Self Traction Therapy: A Case Report

Kim, Yong Min; Won, Choong Hee; Seo, Joong Bae; Choi, Eui Seong; Lee, Ho Seung; Ko, Sang Wook; Kim, Eung Rok

Abstract

STUDY DESIGN: A retrospective case report of lumbar disc herniation with cauda equina syndrome after self traction therapy.
OBJECTIVES
Documentation of clinical significance and manifestations of disc herniation with cauda equina syndrome as one of the complications after self traction therapy. SUMMARY OF BACKGROUND DATA: Various conservative managements of acute low back pain in adults such as traction, spine manipulation therapy(SMT), and exercise therapy may produce harmful complications, especially when performed by non-professional therapists. Recently, reports of complication from SMT are increasing, however, understanding of biomechanism and natural history of traction, SMT, and exercise therapy are still poor. Therefore background information on the possible complications from their management is essential for physicians. METHOD: A case of acute cauda equina syndrome after self traction therapy in a 41 year-old man. Magnetic resonance imaging revealed severe compression of cauda equina by a huge mass. Emergency lumbar laminectomy was performed and all the compressing mass was removed. The mass was proven to be prolapsed disc of nearly whole nucleus amount and scanty nucleus was found within the disc space. RESULT: Acute low back pain and radiating pain disappeared immediately after operation. And neurologic deficits began to improve after postoperative 1 week. At the 15 month follow-up, the patient had recovered fully except minimal paresthesia on the right foot.
CONCLUSION
More attentions to the possibility and clinical features of this complication seemed to be needed to the clinicians and therapists who do conservative management for the low back problems, especially SMT, traction, exercise therapy etc.