Cauda Equina Syndrome

Cauda Equina Syndrome Sections

• Description of the Cauda Equina Nerve Roots
• Causes of Damage to the Cauda Equina
• Symptoms of Cauda Equina Syndrome
• Diagnosis of Cauda Equina Syndrome
• Treatment of Damage to the Cauda Equina
• Prevention of Cauda Equina Syndrome

Description of the Cauda Equina Nerve Roots

Although Cauda Equina Syndome is technically not a spinal cord injury, it may still result in paraplegia. The spinal cord usually terminates between the first and second lumbar vertebra forming the conus medullas. Emerging from this is a bundle of lumbar and sacral nerve roots called the cauda equina, which is Latin for horses tail, because of their appearance. These nerves serve sphincter muscles and sexual function, perineal sensation, sensation and motor function throughout the legs. Damage to this area is known as Cauda Equina Syndome (CES).

Causes of Damage to the Cauda Equina

Cauda Equina Syndome can be caused by a number of different processes, both traumatic and atraumatic. Causes may include fracture or dislocation of the lumbar part of the spine, epidural haematoma (a collection of blood that compresses the nerves), penetrating injury such as a gunshot or a stab wound, herniated lumbar discs, spinal stenosis, neoplasms (tumours), inflammatory conditions such as Paget's disease and ankylosing spondylitis and infectious conditions such as spinal or epidural abscesses.

Not all spinal roots may be damaged and symptoms may be asymmetrical or unilateral

Symptoms of Cauda Equina Syndrome

Symptoms of Cauda Equina Syndome may include lower back pain with uni or bilateral weakness and/or sensory abnormality in the legs. Usually asymmetrical weakness with the loss of the reflex dependent on the affected nerve root. Bowel and/or bladder dysfunction with saddle anaesthesia (loss of sensation in the areas where one sits on a saddle) Urinary dysfunction may present as urinary retention or incontinence and bowel dysfunction may include faecal incontinence or constipation. There may be loss of anal tone and sensation. There may also be sexual dysfunction with impotence, loss of the ability to ejaculate and orgasm.

Diagnosis of Cauda Equina Syndrome

It is usually diagnosed by imaging along with history and examination. The physical exam will include testing the muscle strength of the lower limbs, evaluating sensation to touch and pain, checking lower limb reflexes and evaluation anal tone, reflex and sensation. X-rays will look for severe arthritis and trauma, a MRI with and without contrast will provide a detailed look at tumours, infection, intervertebral disks, and nerve roots.

Treatment of Damage to the Cauda Equina

Cauda Equina Syndome is considered a medical emergency and often prompt surgical decompression of the roots is required to prevent permanent neurological damage.

Medical treatment may be appropriate in certain circumstances depending on the underlying cause of the Cauda Equina Syndome. Anti-inflammatory drugs such as NSAIDS or corticosteroids can be effective in inflammatory diseases. If caused by infection then antibiotics are administered and people with tumours may receive chemo or radiation therapy

Post operatively lifestyle issues may need addressing such as obesity. Physiotherapy and occupational therapy maybe required depending on residual lower limb dysfunction

Prevention of Cauda Equina Syndrome

Prevention of Cauda Equina Syndome is focused on early diagnosis by identifying the symptoms. While low back pain with leg pain and/or weakness is a common complaint that affects many people, Cauda Equina Syndome is a rare complication. Recovery depends on early intervention, late diagnosis and treatment lead to more complications and increases the risk of permanent neurological damage, a degree of bladder and/or bowel dysfunction may be permanently lost