Cauda Equina Syndrome in a Polytrauma Patient: A Case Report

Case Diagnosis: Spinopelvic disassociation causing cauda equina syndrome

Case Description or Program Description: A 41-year-old female with postpartum depression with polytrauma after falling six floors in a suicide attempt was admitted to inpatient rehabilitation. She suffered from intra-abdominal injuries, lower extremity long bone fractures, spinopelvic dissociation, and left below-the-knee amputation. She underwent surgical intervention for her injuries including spinopelvic fusion due to the multilevel dissociation. The patient was initially thought to be neurologically intact in acute care, however upon initial evaluation at inpatient rehabilitation she lacked perineal sensation and did not have control of her bowel or bladder function. A neurological evaluation, including rectal examination, revealed cauda equina syndrome with neurogenic bowel/bladder. With the implementation of a lower motor neuron bowel/bladder program the patient was able to meet her rehabilitation goals.

Setting: Inpatient rehabilitation

Assessment/Results: After undergoing a comprehensive rehabilitation program, the patient’s functional status improved significantly. She ultimately was able to ambulate independently with her prosthesis, and regained sensation and control for bowel and bladder function.

Discussion (relevance): Spinopelvic dissociation, also known as “suicide jumper’s fracture,” is from high-velocity impact resulting in bi-directional rotational instability between the superior and inferior parts of the body. It is the least common type of sacral fracture, but it is associated with a higher incidence of neurological deficits including cauda equina syndrome. Classic presentation includes motor weakness of the lower extremities, perineal numbness, and lower motor neurogenic bowel/bladder dysfunction. Early diagnosis and decompression of the nerve roots minimizes neurological deficits and can improve long-term prognosis.

Conclusions: This is a rare case of a patient with polytrauma whose cauda equina syndrome due to spinopelvic disassociation was not diagnosed until her inpatient rehabilitation admission. The importance of obtaining a thorough history and neurological examination in a rehabilitation setting, especially for patients who present with high-risk injuries cannot be understated as neurological deficits impact rehabilitation goals of care.