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Cauda Equina Syndrome Due to Vigorous Back Massage With Spinal Manipulation in a Patient With Pre-Existing Lumbar Disc Herniation: A Case Report and Literature Review

Yang, Si-Dong MD; Chen, Qian MD; Ding, Wen-Yuan MD
American Journal of Physical Medicine & Rehabilitation: Post Author Corrections: August 07, 2017
doi: 10.1097/PHM.0000000000000809
Case Report: PDF Only


Cauda equina syndrome (CES) resulting from acute lumbar disc herniation due to spinal massage is extremely rare. We present a case of CES caused by the acute worsening of a lumbar disc herniation after a vigorous back massage that included spinal manipulation. After vigorous back massage with spinal manipulation performed by a massage therapist, a 38-yr-old male patient experienced CES with severe numbness in both lower limbs, inability to walk due to weakness of bilateral lower limbs, and incontinence of urine and feces. The magnetic resonance imaging and computer tomography scan results showed that the L4–5 disc herniated down into the spinal canal, extensively compressing the ventral dural sac. The patient was successfully treated with an emergency operation including laminectomy, spinal canal decompression, discectomy, interbody fusion, and pedicle screw fixation. The muscle power in both lower limbs of the patient recovered rapidly to support standing only 1 wk later. Moreover, he regained continence of urine and feces. In conclusion, this case brings us novel knowledge that spinal massage or manipulation may worsen pre-existing disc herniation causing CES, and a timely emergency surgery is necessary and effective for treatment of CES-related symptoms.

All correspondence and requests for reprints should be addressed to: Wen-Yuan Ding, MD, Department of Spinal Surgery, The Third Hospital of Hebei Medical University; Hebei Provincial Key Laboratory of Orthopedic Biomechanics, 139 Ziqiang Rd, Shijiazhuang 050051, PR China.

S-DY and QC contributed equally to this work and are co-first authors.

The authors declare that none of them have any financial and personal relationships with other people or organizations that can inappropriately influence the quality of the work presented in this article. There is no funding received in this study.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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