Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2022; 10(13): 4294-4300
Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4294
Spinal canal decompression for hypertrophic neuropathy of the cauda equina with chronic inflammatory demyelinating polyradiculoneuropathy: A case report
Lei Ye, Wei Yu, Nai-Zheng Liang, Ying Sun, Li-Fen Duan
Lei Ye, Wei Yu, Nai-Zheng Liang, Department of Neurosurgery, The Kunming Children’s Hospital, Kunming 650100, Yunnan Province, China
Ying Sun, Li-Fen Duan, Department of Epilepsy, The Kunming Children’s Hospital, Kunming 650100, Yunnan Province, China
Author contributions: Ye L was the patient’s neurosurgeon and contributed to manuscript-drafting; Duan LF, Liang NZ, Yu W and Sun Y reviewed the literature; all authors issued final approval for the version to be submitted.
Supported by the Yunnan Provincial Department of Science and Technology Kunming Medical University Application Foundation Research Joint Fund Project, No. 202001AY070001-273; the Epilepsy Research Fund of China Anti-Epilepsy Association, No. CQ-B-2021-04; and the Kunming Health Science and Technology Talent Training Project and “100 thousand” Project Training Plan, No. 2021-SW (province)-23.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Fen Duan, MD, Doctor, Department of Epilepsy, The Kunming Children’s Hospital, No. 288 Qianxing Road, Xishan District, Kunming 650100, Yunnan Province, China. duanlifen@etyy.cn
Received: November 20, 2021
Peer-review started: November 20, 2021
First decision: December 27, 2021
Revised: January 5, 2022
Accepted: March 7, 2022
Article in press: March 7, 2022
Published online: May 6, 2022
Processing time: 160 Days and 19.5 Hours
Abstract
BACKGROUND

Hypertrophic neuropathy of the cauda equina (HNCE) is a rare disease, especially in children. It can be caused by different etiological agents such as inflammation, tumor or hereditary factors. Currently, there is no uniform standard for clinical treatment of HNCE. Furthermore, it is unclear whether spinal canal decompression is beneficial for patients with HNCE.

CASE SUMMARY

We report the case of a 13-year-old boy with enlargement of the cauda equina. The onset of the disease began at the age of 6 years and was initially marked by radiating pain in the buttocks and thighs after leaning over and weakness in the lower limbs when climbing a ladder. The child did not receive any medical treatment. As the disease slowly progressed, the child needed the help of others to walk, and he had a trendelenburg gait. He underwent spinal canal decompression and a nerve biopsy during his hospital stay. A diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy was made based on electrophysiological findings and pathological examination results. Immunoglobulin or hormone therapy was recommended during hospitalization, but his mother refused. After discharge, the boy’s mother helped him carry out postoperative rehabilitation training at home. His lower-limb muscle strength gradually increased, and he could stand upright and take steps. Six mo after surgery, the child was readmitted and began immunoglobulin therapy. Long-term oral steroid treatment was initiated after discharge. The movement and sensation of the lower limbs were further improved, and the boy could walk normally 1 year after surgery.

CONCLUSION

Spinal canal decompression can improve the clinical symptoms of HNCE caused by inflammation, even in children. When combined with specific etiological interventions, spinal cord decompression can lead to optimal outcomes.

Keywords: Child; Cauda equina; Polyradiculoneuropathy; Chronic inflammatory demyelinating polyradiculoneuropathy; Laminectomy; Case report

Core Tip: The rare case reported here thoroughly illustrates that chronic inflammatory demyelinating polyradiculoneuropathy can result in hypertrophic neuropathy of the cauda equina (HNCE) in children. This case provides new insights into the management of childhood chronic inflammatory demyelinating polyradiculoneuropathy. We demonstrated that laminectomy, followed by adjunct therapy, is a safe and effective treatment of HNCE. At the same time, etiological diagnosis is very important.