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Case Report
Cauda equina syndrome after a physical therapy session: A case report
1 Medical student at Iguaçu University, Iguaçu University - UNIG/RJ, Nova Iguaçu - RJ, Brazil
2 Professor of Neurology - Universidade Iguaçu - UNIG-RJ, Nova Iguaçu - RJ, Brazil; Physician of the Neurology Service of Nova Iguaçu General Hospital, Nova Iguaçu, RJ, Brazil
3 Department of Neurology of Hospital Geral de Nova Iguaçu, Adjunct Professor of Medicine at Iguaçu University - UNIG/Nova Iguaçu, RJ, Brazil
Address correspondence to:
Antonio Marcos da Silva Catharino
Rua Gavião Peixoto 70, Room 811, CEP 24.2230-100, Icaraí, Niterói-RJ,
Brazil
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Article ID: 101508Z01DP2025
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Pereira DA, Dantas SAB, de Castro Felicio F, Santos PSM, Canedo GM, da Silva Catharino AM. Cauda equina syndrome after a physical therapy session: A case report. Int J Case Rep Images 2025;16(1):106–110.ABSTRACT
Introduction: With the growing aging population, there is an increasing prevalence of degenerative diseases of the lumbar spine, among which lumbar disc herniation is the most common. This condition occurs when the nucleus pulposus breaks through the annulus fibrosus and compresses the nerve roots. Intradural disc herniation (IDDH), where the nucleus penetrates the dura mater, is rare, accounting for only 0.04–0.33% of cases. The lumbosacral region is crucial for supporting body weight, and imbalances can lead to instability and pain, often manifesting as sciatica. Low back pain affects 70–80% of the population in industrialized countries, increasing after age 25 and peaking between 55 and 64 years. Sciatica, common in these cases, refers to pain radiating to the lower limbs and can be true, pseudoradicular, or cruralgia. This article explores the case of an elderly patient who, after a physical therapy session, presented with disc bulging and irregularities in the cauda equina, likely due to compression.
Case Report: An 88-year-old woman with a history of osteoarticular changes in the lumbar spine experienced worsening symptoms over two months. After a session of global postural reeducation (RPG), she developed severe lower back pain and weakness in her lower limbs, preventing her from standing. Physical examination showed bilateral patellar hyporeflexia and indifferent plantar reflexes. Lumbar spine magnetic resonance imaging (MRI) revealed diffuse disc bulging and a broad-based median protrusion at L2–L3, compressing the dural sac and narrowing the spinal canal. Irregularities in the cauda equina fibers above this area were also noted, likely due to compression.
Conclusion: After the review to compose the discussion of this study, it is concluded that cauda equina disorder is a rare pathology, for which the treatment of choice is decompressive surgery. As it is a rare case, this research contributes to the medical literature, with the aim of supporting other professionals to better manage cases.
Keywords: Cauda equina syndrome, Lumbar disc herniation, Radiculopathy
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Author Contributions
Daniel Antunes Pereira - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shara Aline Bueno Dantas - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Felipe de Castro Felicio - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Paula Stephany Maciel Santos - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Gilberto Canedo M Jr - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Antonio Marcos da Silva Catharino - Substantial contributions to conception and design, Acquisition of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Daniel Antunes Pereira et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
