The cauda equina is the continuation of nerve roots in the lumbar and sacral region.
Diagnosis can be done through taking patient history and physical exam and conducting MRI OR CT Scans.
Prompt surgery is the best treatment for patients with this syndrome.
The spinal cord ends at the upper portion of the lumbar (lower back) spine. The individual nerve roots at the end of the spinal cord that provide motor and sensory function to the legs and the bladder continue along in the spinal canal. The cauda equina is the continuation of these nerve roots in the lumbar and sacral region. These nerves send and receive messages to and from the lower limbs and pelvic organs.
Cauda equina syndrome (CES) occurs when there is dysfunction of multiple lumbar and sacral nerve roots of the cauda equina.
Cauda equina syndrome can present in two ways: acute onset, where the symptoms and signs occur rapidly, and insidious onset, where the condition begins as lower back pain and slowly progresses to the bowel and urinary incontinence.
Cauda equina syndrome is most commonly resulting from a massive herniated disc in the lumbar region. A single excessive strain or injury may cause a herniated disc. However, many disc herniations do not necessarily have an identified cause.
Potential causes
•Spinal lesions and tumors
•Spinal infections or inflammation
•Lumbar spinal stenosis
•Violent injuries to the lower back (gunshots, falls, auto accidents)
•Birth abnormalities
• Spinal hemorrhages
•Postoperative lumbar spine surgery complications
•Spinal anesthesia
Symptoms and diagnosis
It is accompanied by a range of symptoms, the severity of which depends on the degree of compression and the precise nerve roots that are being compressed.
Patients with Cauda equine syndrome may experience some or all of these “red flag” symptoms.
•Urinary retention: the most common symptom. The patient’s bladder fills with urine, but the patient does not experience the normal sensation or urge to urinate.
•Urinary and/or fecal incontinence. The overfull bladder can result in incontinence of urine. Incontinence of stool can occur due to dysfunction of the anal sphincter.
•Sensory disturbance, which can involve the anus, genitals and buttock region.
•Weakness or paralysis of usually more than one nerve root. The weakness can affect the lower extremities.
•Pain in the back and/or legs (also known as sciatica).
•Sexual dysfunction.
If a patient is experiencing any of the “red flag” signs, immediate medical attention is required to evaluate whether these represent CES.
Diagnosis
This can be done through taking patient history and physical exam and conducting MRI OR CT Scans.
Treatment
Those experiencing any of the red flag symptoms should be evaluated by a neurosurgeon or orthopedic spine surgeon as soon as possible. Prompt surgery is the best treatment for patients with this syndrome. This should be followed up by Physiotherapy rehabilitation and exercise programme for a steady recovery.
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