Physiotherapy Intervention for Bladder, Bowel, and Functional Mobility Recovery in Neglected Cauda Equina Syndrome Post L4–l5 Discectomy and Fusion: A Case Report

Cauda Equina Syndrome (CES) is a rare and potentially debilitating condition that results from severe compression of the cauda equina nerve roots in the lumbar spine. This syndrome can lead to a variety of symptoms, lower back pain, leg weakness, bladder and bowel dysfunction, sexual dysfunction, saddle anaesthesia and reduced functional mobility. Timely intervention is essential to optimize outcomes, but neglected cases pose a unique challenge in rehabilitation. This subject a 65-year-old female, presented with numbness and weakness of bilateral lower limbs with low back pain on and off for the past 15 years which worsened for the past two years leading to complete loss of bladder and bowel control and weakness of the lower limb muscles with loss of sensation of bilateral foot and saddle anaesthesia pattern. The subject had undergone decompression discectomy L4-L5 with posterior lumbar inter body fusionL4-L5, but due to a delayed intervention, neurological deficits persisted. A comprehensive physiotherapy management program was implemented, including Electrical Stimulation, core stabilization exercises, lower limb strengthening exercises, gait training, and bladder and bowel retraining. Over an eight weeks’ period, the patient demonstrated significant improvements in motor power in lower limbs, bladder bowel function and functional mobility and quality of life. This single case study brings lights on physiotherapy management on a neglected case of CES after decompression and stabilization prognosis is good and the patient can have a better quality of life. Physiotherapy intervention appeared to play a crucial role in enhancing the patient's overall well-being.