【Chiropractic Case Report】Thoracolumbar disc herniation: a hidden cause of monosymptomatic nocturnal enuresis
ABSTRACT A 30-year-old male with a 4-year history of chronic back pain complained of recent episodes of sharp mid back pain referred to his right sacroiliac joint and gluteal area, presumably resulting from twisting injury occurred while playing basketball one week prior. Magnetic resonance imaging showed obvious intervertebral disc degeneration and a right paracentral soft disc herniation compressing the spinal cord at the T12/L1 level. The patient experienced significant pain relief and was able to regain significant mobility of his mid back within two weeks after starting chiropractic care. Moreover, the patient also reported a multi-year history of nocturnal enuresis without daytime symptoms. He unexpectedly found that the symptoms of enuresis spontaneously resolved during the course of treatment. Monosymptomatic nocturnal enuresis under discussion was an uncommon consequence of spinal cord compression (conus medullaris syndrome) caused by thoracolumbar disc herniation.
1. Von Gontard A, Cardozo L, Rantell A, Djurhuus JC. Adolescents with nocturnal enuresis and daytime urinary incontinence— How can pediatric and adult care be improved—ICI-RS 2015. Neurourol Urodynam 2017;36:843–849.
2. Adam A, Claassen F, Coovadia A, et al. The South African guidelines on enuresis2017. Afr J Urol 2018;24(1):1-13.
3. Selvaraj PR, Thirumalai R. Late adolescent primary nocturnal enuresis: a case report. Int J Res Med Sci 2017;5(11):5075-5078.
4. Brauge D, Madkouri R, Clement R, et al. What are the possibilities of spontaneous resorption of a thoracic disc herniation occupying more than 20% ofthe spinal canal in the asymptomatic subject? Comparative study. J Clin Neurosci 2017; 44:269-273.
5. Shah A, Botchu R, Grainger MF, et al. Acute symptomatic calcific discitis in adults: a case report and review of literature. Skeletal Radiol 2015;44(12):1819– 1824.
6. Inoue T. Pure conus medullaris syndrome without lower extremity involvement caused by intradural disc herniation at L1/2: a case report. Spine Surg Relat Res 2019;3:392–395.
7. Nene Y, Jilani TN. Neuroanatomy, conus medullaris. In: StatPearls, Internet. Treasure Island, FL: StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545227/.
8. Brouwers E, van de Meent H, Curt A, et al. Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review. Spinal Cord 2017;55:886–890.
9. Rider IS, Marra EM. Cauda equina and conus medullaris syndromes. In: StatPearls, Internet. Treasure Island, FL: StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537200/.
10. Yeung CK, Sit FK, To LK, et al. Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int 2002;90(3):302–307.
11. Siracusa G, Sparacino A, Lentini VL. Neurogenic bladder and disc disease: a brief review. Curr Med Res Opin 2013;29(8):1025–1031.
12. Reed WR, Beavers S, Reddy SK, Kern G. Chiropractic management of primary nocturnal enuresis. J Manipulative Physiol Ther 1994;17:596–600.
13. van Poecke AJ, Cunliffe C. Chiropractic treatment for primary nocturnal enuresis: a case series 33 consecutive patients. J Manipulative Physiol Ther 2009; 32:675– 81.
14. Instebø E, Lystad RP. Chiropractic care of an 8-year-old girl with nonorganic, primary nocturnal enuresis: a case report. J Chiropr Med 2016;15:47–52.
15. Chu ECP, Chakkaravarthy DM, Lo FS, Bhaumik A. Regression of lumbar disc herniation following nonsurgical treatment. Eur J Mol Clin Med 2020;7(1): 27– 29.