Sacral root injury during trans-sacral epiduroscopic laser decompression: A case report

RATIONALE: Trans-sacral epiduroscopic laser decompression (SELD) is reported to have strong positive short-term effects in controlling lower back pain (LBP) or radicular leg pain following herniated lumbar disc (HLD). However, little is known about the possible complications following SELD. PATIENT CONCERNS: A 36-year-old man received SELD with YAG laser for controlling LBP and radicular pain due to HLD on L5-S1. However, after SELD, voiding and defecation difficulties and sensory deficits on the S3-5 dermatome were presented. DIAGNOSES: An areflexic neurogenic bladder was demonstrated by a urodynamic study four days after onset of sacral nerve root injury symptoms. In the electromyogram study, latency of electrically induced bulbocavernosus reflex (BCR) was delayed on both sides at four days after symptom onset. Based on the patient's symptoms and the results of the clinical evaluation, we diagnosed the patient as having an injury in the sacral nerve roots. INTERVENTIONS: The patient was observed without any specific medication. OUTCOMES: Three months after symptom onset, the patient's voiding and defecation difficulties were nearly completely recovered. LESSONS: In this study, we described a patient who showed neurogenic bladder and bowel and sensory deficits in the S3 to S5 dermatome due to sacral nerve root injury after SELD. During SELD, clinicians should be mindful of the possibility of injury to sacral nerve roots.