Our Summary

This research paper discusses the case of a 48-year-old woman who has been dealing with Crohn’s disease for over two decades. Crohn’s disease is a type of inflammatory bowel disease that affects the digestive tract, and it can lead to abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. The woman was being treated with a drug called infliximab, which is used to reduce inflammation and pain in certain autoimmune diseases.

However, she developed a condition called cauda equina syndrome after a minor surgery to her lower back (L5-S1 microdiscectomy) that was performed to cure her sciatica (leg pain often caused by a herniated disc in the lower back). Cauda equina syndrome is a severe condition where the bundle of nerve roots at the bottom of the spinal cord become damaged, leading to loss of feeling or movement in the legs, and issues with bladder, bowel, and sexual function.

An MRI scan after the surgery showed that her nerve roots were clumping together, but there was no sign of any lesion or injury causing compression. The researchers in this paper discuss the possibility that the cauda equina syndrome might be related to her ongoing Crohn’s disease, the treatment she was receiving, or the surgery itself.

FAQs

  1. What is cauda equina syndrome and how does it relate to minimally invasive microdiscectomy?
  2. Can Crohn’s disease and its treatment with infliximab contribute to the development of cauda equina syndrome?
  3. What did the postoperative magnetic resonance imaging examination reveal about the patient’s condition following the microdiscectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about microdiscectomy is to follow post-operative instructions carefully, including avoiding heavy lifting and strenuous activity for a certain period of time to allow for proper healing of the surgical site. It is also important to attend all follow-up appointments and communicate any changes or concerns with your doctor promptly.

Suitable For

Patients who are typically recommended for microdiscectomy are those who have a herniated disc in the lumbar spine that is causing severe pain, weakness, or numbness in the legs. This procedure is often recommended for patients who have not responded to conservative treatments such as physical therapy, medication, or injections. Additionally, patients who have symptoms of cauda equina syndrome, such as bladder or bowel dysfunction, may also be recommended for microdiscectomy to relieve pressure on the nerves in the lower spine.

Timeline

Before microdiscectomy:

  1. Patient experiences severe lower back pain and sciatica symptoms, such as leg pain and numbness.
  2. Patient undergoes imaging tests, such as MRI or CT scan, to diagnose the cause of their symptoms.
  3. Patient may undergo conservative treatments, such as physical therapy or medication, to manage their symptoms.

After microdiscectomy:

  1. Patient undergoes minimally invasive microdiscectomy surgery to remove the herniated disc causing their symptoms.
  2. Patient experiences relief from their sciatica symptoms following the surgery.
  3. Patient undergoes postoperative imaging tests to assess the success of the surgery.
  4. In some cases, patient may develop complications such as cauda equina syndrome, characterized by dysfunction of lumbosacral nerve roots.
  5. Patient may require further treatment or management for the cauda equina syndrome, such as medication or physical therapy.
  6. Overall, the microdiscectomy surgery helps improve the patient’s quality of life by alleviating their sciatica symptoms.

What to Ask Your Doctor

  1. What is a microdiscectomy and how does it work to treat my condition?
  2. What are the potential risks and complications associated with a microdiscectomy procedure?
  3. How long is the recovery period after a microdiscectomy and what can I expect during this time?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. Are there any restrictions or limitations on activities that I should be aware of after the surgery?
  6. How likely is it that my symptoms will improve or be completely resolved after the microdiscectomy?
  7. Are there any alternative treatment options to consider before proceeding with a microdiscectomy?
  8. Will my Crohn’s disease or any other medical conditions affect my eligibility for a microdiscectomy procedure?
  9. How will my current medications, such as infliximab, impact the surgery and my recovery?
  10. What follow-up care or monitoring will be necessary after the microdiscectomy procedure?

Reference

Authors: Raftopoulos C, Koenig S, Joris V, Duprez T. Journal: Neurochirurgie. 2017 Mar;63(1):21-24. doi: 10.1016/j.neuchi.2016.10.007. Epub 2017 Mar 9. PMID: 28285756