Cauda Equina Syndrome

June 09 23:49 2019 Print This Article

Cauda equina syndrome is a serious neurologic condition in which there is acute loss of function of the neurologic elements (nerve roots) of the spinal canal below the termination ( conus ) of the spinal cord. The syndrome is characterized by dull pain in the lower back and upper buttocks and lack of feeling ( analgesia ) in the buttocks, genitalia and thigh, together with disturbances of bowel and bladder function.

Cauda equina syndrome (CES) occurs when the nerve roots are compressed and paralyzed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage. If you don’t get fast treatment to relieve the pressure, CES may cause permanent paralysis, impaired bladder and/or bowel control, loss of sensation and other problems. Even if the problem gets treatment right away, you may not recover complete function.

Cauda equina syndrome is a condition caused by compression of the spinal nerves in the lowest region of the spinal canal (lumbar spine). Symptoms of cauda equina syndrome include low back pain, pain radiating to the legs, numbness or paralysis in the legs, saddle anesthesia, and bowel or bladder incontinence. The cauda equina (Latin for “horse’s tail”) refers to the sack of nerve roots with a common covering at the end of the spinal cord that is the continuation of these nerve roots in the lumbar region.

Cauda equina syndrome most commonly results from a massive disc herniation in the lumbar region. A disc herniation occurs when one of the soft flexible discs that functions as an elastic shock absorber between the bones of the spinal column herniates or displaces from its normal position. The herniation occurs after the disc begins to break down with aging and can be precipitated by stress or a mechanical problem in the spine. The result is that the softer, center portion of the disc pushes out and causes pressure on the nerve roots in the lumbar spine. Cauda equina syndrome is caused by this compression on the nerve roots.

Causes of Cauda Equina Syndrome

This condition may be caused by a ruptured disc (which provides a cushion between the bones of the spine and space for the nerves to pass from the spinal cord to other parts of the body), a tumor, infection, a fracture or a narrowing of the space through which the spinal cord passess may bring this on. It may also happen because of a violent impact such as a car crash, fall from significant height or penetrating (i.e., gunshot, stab) injury. Sometimes children are born with spinal problems that cause this condition.

  • Injury (spinal fractures).
  • Tumours of the cauda equina.
  • Vascular (blood vessel) problems of the cauda equina.
  • Herniated discs.

Signs and Symptoms of Cauda Equina Syndrome

Cauda equina syndrome is accompanied by a range of symptoms, the severity of which depend on the degree of compression and the precise nerve roots that are being compressed. Symptoms include severe low back pain, urinary or bowel incontinence, motor weakness or sensory loss in both legs, and saddle anesthesia (unable to feel anything in the body areas that would sit on a saddle).

  • Numbness around the genitals.
  • Difficultly controlling the bowel and/or bladder.
  • Progressive numbness or weakness of the legs.

Treatment for Cauda Equina Syndrome

Cauda equina syndrome can become permanent if the symptoms are not properly addressed. Patients who have cauda equina may require emergency surgical treatment in order to relieve pressure on the affected nerves. Treating patients within 48 hours after the onset of the syndrome provides a significant advantage in improving sensory and motor deficits as well as urinary and rectal function. But even patients who undergo surgery after the 48-hour ideal time frame may experience significant improvement, too. Although short-term recovery of bladder function may lag behind reversal of lower extremity motor deficits, the function may continue to improve years after surgery.

Following surgery, drug therapy coupled with intermittent self-catheterization can help lead to slow but steady recovery of bladder and sphincter function. Although steroids have proven useful in the treatment of spinal cord injury and some physicians advocate steroids for cauda equina syndrome, no evidence suggests that they are useful in treatment of cauda equina compression.

  • Rest and drugs to reduce swelling and pain
  • Surgery to take the pressure off the nerves is the best treatment. Treating patients within 48 hours provides an important advantage in improving sensory and motor deficits as well as bowel function.

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