Cauda equina syndrome in an obese parturient following cesarean section under combined spinal–epidural anesthesia

Cauda equine syndrome (CES) is the very rare complication especially after uneventful neuraxial anesthesia. A woman underwent a combined spinal-epidural anesthesia for cesarean section. Postoperatively 24 hours, she complained of paresthesia of the left leg, urinary retention, and saddle anesthesia. After checking magnetic resonance imaging (MRI), CES was suspicious and medical treatment was initiated. During the 18-month follow-up, though perineal hypoesthesia and paresthesia of the left leg were recovered, urinary and fecal incontinence remained. This case demonstrates that CES may occur even after an uneventful combined spinal-epidural anesthesia (CSEA) in obese patients with subclinical spinal epidural lipomatosis (SEL) and disc herniation.