What are possible iatrogenic causes of cauda equina syndrome (CES)?

Updated: Jun 14, 2018
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

Complications of spinal instrumentation have been reported to cause cases of cauda equina syndrome, including misplaced pedicle screws [61] and laminar hooks. [62, 63] Continuous spinal anesthesia also has been linked to cases of cauda equina syndrome. [64]

Rare cases of cauda equina syndrome caused by epidural steroid injections, fibrin glue injection, [65] and placement of a free-fat graft have been reported. [66]

Several cases have involved the use of hyperbaric 5% lidocaine for spinal anesthesia. Recommendations are that hyperbaric lidocaine not be administered in concentrations greater than 2%, with a total dose not to exceed 60 mg. [67, 68]

Medical and surgical situations such as bone screw fixation, fat grafts, lumbar arthrodesis for spondylolisthesis, lumbar discectomy, intradiscal therapy, lumbar puncture forming an epidural hematoma, chiropractic manipulation, and a bolus injection of anesthetic during spinal anesthesia have been related to the development of cauda equina syndrome–like syndromes. [35, 69, 70, 71, 72, 73]


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