Cauda Equina Syndrome
Cauda Equina Syndrome (CES) is technically not a spinal cord injury, though it is often referred to as one by the medical community – and may result in paraplegia.
In the case of CES 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.
When the damaged spinal nerves result in paralysis it is known as Cauda Equina syndrome (CES). CES occurs in approximately 2% of cases of herniated lumbar discs.
What Are You Looking For?
1. About Causa Equina Syndrome
2. Symptoms
3. Diagnosis
4. Treatment
5. Classification
6. Prevention
Cauda Equina syndrome is technically not a spinal cord injury, is often referred to as one by the medical community & may result in paraplegia. The spinal cord usually terminates between the first & second lumbar vertebra forming the Conus Medullas. Emerging from this is a bundle of lumbar & sacral nerve roots called the Cauda Equina, which is Latin for horses tail, because of their appearance.
These nerves serve the sphincter muscles, sexual function, perineal sensation, and the sensation and motor function in the legs.
The damaged spinal nerves in the Cauda Equina which result in paralysis are located in the following areas:
– Lumbar nerves: L1-L5
– Sacral nerves: S1-S5
– 1 Coccygeal nerve: Coc1 – responsible for sensation over the coccyx.
Damage to this area is known as Cauda Equina syndrome (CES). CES occurs in approximately 2% of cases of herniated lumbar discs.
Symptoms of CES 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 tone and sensation.
There may also be sexual dysfunction with impotence, loss of the ability to ejaculate and orgasm.
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, inter-vertebral disks, and nerve roots.
Cauda equina syndrome is considered a medical emergency & 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 syndrome. Anti-inflammatory drugs such as NSAIDS or corticosteroids can be effective in inflammatory diseases. If caused by infection then antibiotics are administered & people with tumours may receive chemo or radiation therapy.
Post operatively lifestyle issues may need addressing such as obesity. Physiotherapy and occupational therapy may be required depending on residual lower limb dysfunction.
Cauda equina syndrome can be diagnosed into two different classifications:
– Incomplete CES (CESI)
– Complete CES (or CES with true retention; CESR).
Prevention of cauda equina syndrome 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 syndrome 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.