Cauda equina syndrome following vaginal hysterectomy in lithotomy position: A case report

Cauda equina syndrome (CES) is a rare but serious complication, often linked to spinal canal narrowing. We present a unique case of CES following vaginal hysterectomy performed in the lithotomy position in a patient with pre-existing spondylolisthesis. A 66-year-old woman with long-standing L4/L5 and L5/S1 spondylolisthesis underwent vaginal hysterectomy. Postoperatively, she developed saddle anesthesia and burning urethral pain. Initially attributed to the gynecological procedure, her symptoms persisted. Three months later, a magnetic resonance imaging revealed spinal canal stenosis and CES. She underwent posterior lumbar interbody fusion, which improved her symptoms. This is only the second reported case of CES following vaginal hysterectomy in the lithotomy position. It underscores the importance of pre-operative spinal assessment and intraoperative positioning, especially in patients with known spinal pathology.