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Can "severe" neural foraminal narrowing cause CES symptoms?

AnonymousUserAAnonymousUser Posts: 49,671
First, let me apologize for the long post. I'm really freaked out and am being treated like dirt!

I've had 5 lumbar surgeries, with zero hardware. I've had Lami's with discectomies from L3-4 down to L5-S1. My last surgery was 8/22/08.

Here's what happened now...

About 10 days ago, I lifted a box roughly 20lbs. I'm 30 years old, 5'11 and in pretty good shape. I immediately had severe low back pain and the shooting pains down both legs. The next day I started having bladder incontinence, numbness in the groin and VERY sadly (and humiliating), failure to get an erection. I should mention that my last 3 surgeries were ALL emergency surgery because I had Cauda Equina Syndrome, so I'm familiar with CES.

My PCP sent me to the ER immediately. They did an MRI and spoke to the surgeon who did my 2nd to last surgery. He said he felt that I was 'drug seeking' and I was told everything was fine. I should also mention that I sued him in '06 and won because he botched the surgery. I didn't know that was the surgeon they were going to call but they did. During the last week my PCP sent me to 3 other ER's and ALL consulted with the same surgeon because he's the only one in Oregon who operated on my back. My PCP has me on pain meds (oxycontin and oxycodone IR), so it's hard to say I'm 'drug seeking' when I have all the 'drugs' I need.

Anyways... My PCP just faxed me over the MRI which shows a new herniation (central) at L2-3, with mild impingement. L3-4 shows moderate super-imposed central protrusion with moderate enhancement of the thecal sac. L4-5 reads identical to L3-4. NOW, for the big one - L5-S1 shows a large/severe left paracentral protrusion resulting in severe left neural foraminal narrowing and moderate right side narrowing.

My PCP is furious and is doing all he can to get me help. He's even suggested that I travel up to Seattle! I have loss of anal tone (his rectal exam), parts of my legs are 100% numb, groin numbness, still have bladder incontinence and failure to get an erection. The surgeon flat out said that there were NO herniations, NO impingement and I now find out he flat-out lied!

The MRI does read better than my previous 3 because those were all severe central herniations, with severe spinal cord compression etc...

Bottom line is that I'm going at about 10 days with these problems and it's scaring me severely. I thought CES needs to be operated on within 48 hours to relieve these symptoms?

Can severe neural foraminal narrowing cause the CES symptomes?

I appreciate any input and would like to thank you all for taking the time to read this. As a new member and having gone through so much with my spine, I will do my best to help others on here in any way that I can. I'm glad I found this site!


  • I also had one episode of loss of bowel control, which happened yesterday morning. Technically it happened in my sleep. I've never (sorry) "crapped the bed" and I don't drink or do drugs (except the pain meds).
  • Sounds like time to check things out in Seattle. I just had a ACDF with a great doctor who practices in Seattle. They won't allow us to give out doctors names so if you want his name send me a private message. I think we can give them out there????
  • I hope you have received treatment by now. I have been travelling and just returned home and turned on the computer. Obviously, or at least one would think it would be obvious to any medical personnel, that you do not have good relations with the doctor who botched a surgery.

    Surely there are other fellowship-trained spinal specialists in the state of Oregon?? With symptoms such as yours, you need to be checked out immediately to rule out CES. I am enclosing a link in case others do not know the dangers of CES. Any patient who has lower lumbar problems needs to be knowledgeable about CES as, in most cases, it does require prompt treatment.


    Please let us know how you are doing and where you had to go to be treated properly.

    xx Gwennie
  • rockfish2013rrockfish2013 Posts: 12
    edited 06/16/2014 - 2:40 AM
    Obviously the answer is YES -- it can indeed cause the symptoms of Cauda Equina Syndrome (CES) because you are having those symptoms. You are describing the classic symptoms of CES that occur with an L5-S1 central canal herniation, but obviously it does not need to be "central." You need emergency surgery or everything you describe may become permanent and some people even become paralyzed. I am posting this very belatedly so I hope you found a surgeon in time to be helped.

    I have severe compression of all Cauda Equina nerve roots due to retrolisthesis (dislocated vertebra) at L2-L3 and actually have different symptoms than yours but even the spine docs might not know that the symptoms can be this different -- no saddle anesthesia YET but numbness on outside of legs, problems with bladder sensation and something weird about bladder and bowels but I haven't figured out if it's harder to go or what?? Just weirdness.

    I found a study in which a guy had L2-L3 cauda eqina compression similar to me and his symptoms were also very similar to mine. By contrast, all the L5-S1 people had the usual saddle anesthesia. The researchers theorized that the nerve roots are able to stretch further at L2-L3 than at L5-S1 so the symptoms may be less severe in L2-L3 cases or maybe just less obvious than a problem at L5-S1. L5-S1 is a very bad place to herniate a disc, I think. Especially if it is a central herniation but this post shows it it's possible with left or right herniations, as well.
  • NOTE -- I have intermittant bladder incontinance, constipation and rare episode of bowel incontinence but cannot be certain it's from my L2-L3 CES, esp. considering I have none of the saddle aesthesia or other common CES symptoms, and because I also have severe C-spine problems that could be the cause.
  • sandisandi Posts: 6,343
    edited 06/16/2014 - 4:38 AM
    This post is from 2009 that you are responding to........Cauda Equina Syndrome effects different areas of the lower body , depending on which levels of the lumbar canal are compromised. There are two forms of CES- CES complete with retention and CES I or CES incomplete. The dermatome map shows where each area of the body is innervated by what level of the spine. In the case of Cauda Equina Syndrome-(CES Complete with true retention), what level the compression of the canal is at, will also effect every level below in some fashion . For example, and L3 canal compression severe enough to cause CES, will effect everything from that dermatome down......and the myotome shows what muscles are effected.
    In CES I, a person may not be effected bilaterally, but unilaterally because of the way the compression is effecting the spinal nerves in the canal. It may compress most of the spinal nerves in the canal but not all, and therefore the damage will result in different losses on each side of the body or only on one side.
    Depending on which level is effected, some may see more issues with their bladder or bowels or both, or loss of sexual function and feeling, or not, as well as the leg and muscle , sensation issues. Loss of the use of legs can occur if the compression is left too long , depending on the area of the lumbar spine effected.
    It is in fact a surgical emergency, and if one experiences or suspects that they have CES, they need to see their surgeon right away. The best outcomes are those that are relieved of the compression within a very short period of time......
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