Case 1: Cauda Equina Syndrome — Midnight Decompression
A 38-year-old man with two weeks of sciatica developed inability to pass urine and numbness in the saddle area over twelve hours. Examination confirmed reduced perianal sensation and a palpable bladder; urgent MRI showed a massive L4-L5 disc extrusion filling the canal. He was decompressed within six hours of presentation — cauda equina syndrome is one of the few absolute emergencies in spine surgery.
Management
Emergency L4-L5 laminectomy and discectomy.
Outcome
Bladder function recovered fully over three weeks; residual mild numbness at 6 months.
Case 2: Sciatica That Would Not Settle — Microdiscectomy After 10 Weeks
A 34-year-old software engineer had L5-S1 disc herniation with S1 sciatica. We treated conservatively — medication, physiotherapy, activity modification, and one epidural steroid injection — for ten weeks, but leg pain remained 8/10 and he could not sit through a work day. MRI findings matched his symptoms exactly, making him an ideal surgical candidate.
Management
L5-S1 microdiscectomy through a 2 cm incision with microscope.
Outcome
Leg pain gone on waking from anaesthesia; back to office at 3 weeks; running at 3 months.
Case 3: Lumbar Canal Stenosis — The Shopping-Cart Sign
A 72-year-old could walk only 150 metres before his legs became heavy and numb, yet cycled 5 km without symptoms — classic neurogenic claudication, relieved by flexion (the 'shopping-cart sign'). MRI showed severe L3-L4 and L4-L5 stenosis. After eighteen months of failed conservative care, decompressive laminectomy at both levels transformed his walking.
Management
L3-L5 decompressive laminectomy preserving facets; no fusion needed (no instability).
Outcome
Walking 2 km at 3 months.
Case 4: Pott's Spine — Tuberculosis Treated Without Surgery
A 29-year-old woman had six months of night sweats, weight loss, and mid-back pain. MRI showed T8-T9 vertebral destruction with a paravertebral abscess; CT-guided biopsy confirmed tuberculosis. With no neurological deficit and kyphosis under 30°, she was treated with anti-tubercular therapy and a brace — the majority of spinal TB never needs an operation.
Management
12 months anti-tubercular chemotherapy, thoracolumbar brace 4 months, serial X-rays.
Outcome
Complete healing with 12° kyphosis; back to work at 5 months.
Case 5: Thoracolumbar Burst Fracture — TLICS Guides the Decision
A 30-year-old fell from a mango tree, sustaining an L1 burst fracture. He was neurologically intact, but MRI showed disruption of the posterior ligamentous complex — TLICS score 5, tipping the decision to surgery. Short-segment pedicle screw fixation one level above and below restored alignment and let him mobilise within days rather than months in a brace.
Management
Posterior pedicle screw fixation T12-L2; mobilised day 2.
Outcome
Solid healing at 6 months; implant removal at 1 year; full return to farm work.
Case 6: Osteoporotic Vertebral Fracture — Kyphoplasty for Unrelenting Pain
A 76-year-old woman had an L1 osteoporotic compression fracture after lifting a bucket. Six weeks of conservative care left her bed-bound with 9/10 pain. Balloon kyphoplasty — inflating a balloon in the vertebra and filling the cavity with cement — gave dramatic relief and let her stand the same evening.
Management
Percutaneous balloon kyphoplasty under local anaesthesia + sedation; osteoporosis treatment started.
Outcome
Pain 2/10 by next morning; walking independently at discharge.
Case 7: Cervical Myelopathy — ACDF for the Clumsy Hand
A 58-year-old typist noticed her fingers fumbling buttons and her walking becoming unsteady — signs of cervical myelopathy, confirmed as C5-C6 disc-osteophyte compression with cord signal change on MRI. Myelopathy is progressive; surgery halts decline and often restores function. Anterior cervical discectomy and fusion removed the compression directly.
Management
C5-C6 ACDF with PEEK cage; collar 4 weeks.
Outcome
Hand dexterity recovered over 4 months; gait normalised.
Case 8: Degenerative Spondylolisthesis — Decompression Plus Fusion
A 63-year-old woman had L4-L5 degenerative spondylolisthesis (grade II slip) with stenosis: back pain plus claudication. Because decompression alone at an unstable, slipped level risks worsening the slip, she received decompression with instrumented posterolateral fusion — screws, rods, and bone graft.
Management
L4-L5 laminectomy + pedicle screw fusion with local bone graft (TLIF cage).
Outcome
Claudication resolved; fusion solid on CT at 1 year.
Case 9: Adolescent Back Pain — When a Stress Fracture Mimics a Muscle Pull
A 15-year-old fast bowler had three months of activity-related low back pain, worse on extension. X-rays were normal, but MRI revealed a unilateral L5 pars stress reaction — early spondylolysis, an overuse injury of young athletes in extension sports. Caught before a complete fracture, it heals without surgery.
Management
3 months off bowling, brace, then graded core-strengthening and bowling-action review.
Outcome
Pain-free return to full bowling at 6 months; healed pars on repeat MRI.
Case 10: Whiplash After a Rear-End Collision — Reassurance, Not a Collar
A 27-year-old presented the morning after a rear-end car collision with neck pain and stiffness. Examination showed no neurological deficit or midline bony tenderness; imaging (per the Canadian C-Spine Rule) was not required. He was treated with reassurance, early movement, and simple analgesia — modern whiplash care is the opposite of the old soft-collar-and-rest approach.
Management
Education, early active neck exercises, paracetamol/NSAIDs, no collar, review at 2 weeks.
Outcome
Full recovery in 5 weeks.
Explore More Cases
This series is part of the OrthoChronicles Surgical Case Library — 50 real-world cases across trauma, joint replacement, spine, paediatric and sports orthopaedics.