Journal of orthopaedic case reports · 2026
Acute Cauda Equina Syndrome Following Transpedicular Biopsy of a Lumbar Vertebral Lesion: A Case Report of Spinal Non-Hodgkin's Lymphoma.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Gohil Kushal R, Gawhale Sangeet K, Barman Jyotishman, Selwal Neha, Agarwal Aditya A, Kumar Prathit
Аннотация
INTRODUCTION: Spinal involvement in non-Hodgkin's lymphoma (NHL) is uncommon and often presents with non-specific clinical and radiological features, frequently mimicking infective or degenerative spinal pathology. Tissue diagnosis using transpedicular biopsy is commonly performed in such cases. However, acute neurological deterioration occurring after biopsy in a pathological vertebra is rare. We report a unique case of acute cauda equina syndrome (CES) developing in close temporal association with transpedicular biopsy of a lumbar vertebral lesion, later diagnosed as NHL.
CASE REPORT: A 60-year-old male presented with low back pain and left-predominant lower limb radiculopathy of 4 weeks' duration, without any bowel or bladder involvement or neurological deficit. Magnetic resonance imaging (MRI) revealed a pathological lesion involving the L4 vertebra, with differential diagnoses including infection and malignancy. A left-sided L4 transpedicular biopsy was performed under local anesthesia, following which the patient remained neurologically intact. On the 4th post-biopsy day, the patient developed acute CES characterized by bilateral lower limb weakness, bilateral flail foot, perianal sensory loss, urinary retention, and constipation. Repeat MRI demonstrated significant cauda equina compression. Histopathological examination confirmed NHL. The patient underwent urgent L4-L5 decompression and stabilization, followed by systemic chemotherapy.
CONCLUSION: Although transpedicular biopsy is considered a safe diagnostic procedure, acute neurological deterioration may rarely occur in patients with pathological vertebral lesions. A definitive causal relationship between biopsy and neurological deterioration cannot be established from a single case; however, this case highlights the importance of close post-procedural neurological monitoring. Early recognition of CES, urgent repeat imaging, and timely decompression, when indicated, are essential to reduce the risk of irreversible neurological deficits.
CASE REPORT: A 60-year-old male presented with low back pain and left-predominant lower limb radiculopathy of 4 weeks' duration, without any bowel or bladder involvement or neurological deficit. Magnetic resonance imaging (MRI) revealed a pathological lesion involving the L4 vertebra, with differential diagnoses including infection and malignancy. A left-sided L4 transpedicular biopsy was performed under local anesthesia, following which the patient remained neurologically intact. On the 4th post-biopsy day, the patient developed acute CES characterized by bilateral lower limb weakness, bilateral flail foot, perianal sensory loss, urinary retention, and constipation. Repeat MRI demonstrated significant cauda equina compression. Histopathological examination confirmed NHL. The patient underwent urgent L4-L5 decompression and stabilization, followed by systemic chemotherapy.
CONCLUSION: Although transpedicular biopsy is considered a safe diagnostic procedure, acute neurological deterioration may rarely occur in patients with pathological vertebral lesions. A definitive causal relationship between biopsy and neurological deterioration cannot be established from a single case; however, this case highlights the importance of close post-procedural neurological monitoring. Early recognition of CES, urgent repeat imaging, and timely decompression, when indicated, are essential to reduce the risk of irreversible neurological deficits.