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Synovial Cysts and the Lithotomy Position Causing Cauda Equina Syndrome
  1. John H Wills, F.A.N.Z.C.A.,
  2. Saul Wiesel, F.R.C.P.C.,
  3. Stephen E Abram, M.D. and
  4. Frederick W Rupp, M.D.
  1. From the Department of Anesthesiology and Critical Care Medicine (J.H.W., S.W.), University of New Mexico, Albuquerque, New Mexico
  2. Department of Radiology (F.W.R.), University of New Mexico School of Medicine, Albuquerque, New Mexico
  3. Department of Anesthesiology (S.E.A.), Medical College of Wisconsin, Milwaulkee, Wisconsin
  1. Reprint requests: John Wills, F.A.N.Z.C.A., Department of Anesthesiology and CCM, MSC 11-6120, 1 University of New Mexico, Albuquerque, NM 87131-0001 USA. E-mail: jwills{at}


We describe a case of cauda equina syndrome caused by synovial cysts and the lithotomy position. A transurethral resection of the prostate was performed under spinal anesthesia in the lithotomy position. We believe that this is the first case report of facet joint synovial cysts and the lithotomy position causing ischemic neurologic injury to the cauda equina. Other etiologies such as needle trauma, neurotoxicity, hematoma, and abscess were not evident. We believe that positioning the patient in the lithotomy position narrowed the cross-sectional area of the spinal canal in a patient with a coexisting critically stenosed lumbar spinal canal. The resultant mechanical pressure caused an ischemic compression injury to the cauda equina.

  • Cauda equina syndrome
  • Spinal anesthesia
  • Spinal stenosis
  • Positioning

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