Rapid progression of acute sciatica to cauda equina syndrome

Objective: To demonstrate the importance of clinical examination and contin ued vigilance for neurologic deterioration in patients with sciatica. Cauda equina syndrome, a rare sequels of sciatica, is considered a medical emerg ency requiring surgical decompression. Clinical Features: A 32-year-old woman had sciatica that rapidly progressed to cauda equina syndrome. Magnetic resonance imaging revealed the presence of a large nonsequestered disk fragment in the lower lumbar spine. Intervention and Outcome: The disk fragment was surgically excised. The pat ient experienced immediate pain relief after surgery but retained neurologi c deficits. After 6 months of rehabilitation, neurologic integrity was rest ored, aside from patchy sensory loss of the left foot and buttocks. At the B-month followup, the patient's sciatica had not returned. Conclusions: Most cases of sciatica, regardless of cause, will self-resolve ; as a result, there might be a tendency to maintain a low index of suspici on for serious, progressive disorders such as cauda equina syndrome. Patien ts need to be educated as to signs of this emergency condition and informed as to the possible consequences of delaying treatment. By maintaining a hi gh index of suspicion for any case that fails to respond as expected to a c ourse of conservative therapy or that demonstrates signs of cauda equina sy ndrome, chiropractors can assume a pivotal role by investigating and referr ing appropriately and by aiding in active rehabilitation postoperatively.