L4/5 Microdiscectomy for Cauda Equina Syndrome

If a prolapsed disc in the L4/5 segment of the spine is compressing the cauda equina nerves, an emergency microdiscectomy will be needed.

Cauda equina syndrome from L4/5 slipped disc

Cauda equina syndrome is a neurological condition which happens when the cauda equina nerves at the bottom of the spine are compressed.

Compression can occur in different ways, including a slipped disc in the L4/5 segment of the spine. The L4/5 vertebral discs are located in the lower back in the lumbar region. If it is a very large disc extrusion, it can press upon the cauda equina nerves, thereby resulting in cauda equina syndrome.

Treating a large L4/5 slipped disc

A slipped disc which is compressing the cauda equina nerves must be treated with surgical decompression. There are different techniques which the surgeon may employ, but most commonly a microdiscectomy will be required. This is when the fragment of the disc which is pressing on the nerves is removed.

Before the procedure, the patient should be consented for L4/5 decompression and discectomy. The aim is to prevent progression of cauda equina syndrome and reduce pain. The patient should be informed of the risks of surgery before signing the consent form. These include:

• Bleeding
• Infection
• Scarring
• CSF leak
• Neurological deficit (motor, sensory, bladder and bowel)
• Continuing symptoms
• The need for further procedures

Timing of surgery

There is not a lot of time to treat cauda equina syndrome. Indeed, it is a medical emergency because the nerves can become irreparably damaged extremely quickly. The microdiscectomy must therefore be carried out before this happens, or the patient will be left with permanent neurological complications.

There are various medical opinions about the precise timing of surgery. Most medical experts believe that acute cauda equina syndrome must be treated within 48 hours of the onset of symptoms. After this point the nerves will become permanently injured, the patient’s condition will progress to the ‘complete’ stage (where there is no bladder control) and a total recovery will not be possible.

L4/5 microdiscectomy for cauda equina syndrome delayed

Sadly medical practitioners do not always manage to carry out a microdiscectomy in time. Sometimes this will happen because the patient only presented to hospital in the complete stages, meaning even emergency treatment would not repair the nerves. But sometimes blame will lie with the medical practitioners themselves – perhaps because a diagnosis was not obtained quickly enough, or because the operation was not arranged upon an emergency basis.

If doctors are at fault for your cauda equina complications, you need to talk to a solicitor about your options. You could be eligible to claim compensation. Contact us for more information.

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