Why Rush to Surgery? A Case Report of Safety Netting and Management of Suspected Cauda Equina Syndrome

Abstract

BACKGROUND: Cauda equina syndrome symptoms may present differently in older adults with lumbar spinal stenosis (LSS), causing unique diagnostic and management challenges. CASE PRESENTATION: A 78-year-old male with LSS reported to an outpatient physical therapy clinic with low back pain, bilateral leg paresthesia, and saddle paresthesia that limited his standing and walking. Symptoms were relieved by sitting. Neurological deficits included diminished medial thigh sensation and lower extremity reflexes. Limited lumbar extension and hip extension were also present. OUTCOME AND FOLLOW-UP: Because symptoms developed gradually, a safety net was established. Manual therapy, exercise, and a walking program were initiated. After 8 visits, the patient's walking distance tripled, and his lower extremity and saddle paresthesia almost completely resolved. After 18 months, his saddle paresthesia resolve and leg pain continued to improve. DISCUSSION: This case report supports current recommendations for watchful waiting and conservative treatment when potential cauda equina syndrome symptoms develop gradually in older adults with LSS. JOSPT Cases 2022;2(4):208–219. Epub: 12 October 2022. doi:10.2519/josptcases.2022.11067