City doctors save 33-year old from cauda equine compression

Bengaluru: The year 2020 holds special for doctors who have showed courage and fortitude in the face of deadly coronavirus to save people from the pandemic. Alongside fighting Covid-19, they have continued to save people from infinite number of other medical problems. The story of Narayanaswamy, 33-year-old from Kolar district, who came back from the brink after suffering from a debilitating fall, thanks to the efforts of doctors, showcases remarkable role being played by medical professionals in providing succor to humanity.

Narayanaswamy was unable to stand on his feet. Worse, he had lost control of his bowel and bladder. This was quite an unusual case for a young man. Upon investigation, doctors at Prakriya Hospital, found the root cause of the problem. He had fallen down a fortnight earlier. Since then he suffered from pain in the right leg.

However, a day before he came to OPD, Narayanaswamy had lifted a heavy sack and felt sudden loss of control in his legs. "The worst part was that he had no sensation of his bladder filling up. He felt tingling and heaviness in his legs. He did not seek any medical attention at that time" the doctors at Prakriya Hospital said. By the time he visited the hospital, it was more than 24 hours since the injury and it could have proved critical if he further delayed seeking medical advice.

Dr Vinu Raj, Consultant, Orthopaedic and Spine Surgeon at Prakriya Hospital, said, "He was on a wheelchair and could not stand. He had very minimal feeling in his legs. He had no sensation of wanting to empty his bladder. He underwent an emergency MRI scan, which showed a large disc compressing the nerves completely in his spine. He had a condition known as cauda equina compression".

The lower part of the spinal cord ends in a tail like fashion- cauda equina or the horse tail. This area is prone to compression by sudden disc prolapses or any other compressing mass, especially in the lower part of the spine, as there is significant load on the discs due to our activities. These nerves carry the sensation from the legs, bladder and bowel to the brain and also carry the commands from the brain to help in moving legs, controlling bladder and the bowels.

"When he had a catheter (tube into bladder) put in, we found he had 1,500 ml in his bladder, whereas the normal capacity of the bladder is only 500-600 ml. This signalled that he had come off worse, as he had gone into urinary retention, where the bladder fills beyond capacity and the patient is not aware of it," Vinu Raj further added.

Acting immediately, doctors performed an emergency surgery on Narayanaswamy the same night, and removed the large disc and as well as all the compression over the nerves. He made a significant recovery and got relief from tingling sensation and numbness.

"I am very fortunate that slowly I got more movement in my legs and could stand with support. By the time I reached home, I was able to stand with minimal support. My bowel movements also improved with certain techniques used for patients with spinal cord injuries. Though I went home with the urinary catheter, it was removed two weeks later. Thanks to the doctors for restoring me to my normal life," an elated Narayanaswamy said.