Cauda Equina Syndrome

Cauda equina syndrome is caused by compression of the cauda equina, the thecal sac that contains the group of nerve roots remaining after termination of the spinal cord at approximately the L1-L2 level. Symptoms of cauda equina syndrome are dominated by bladder (and possibly bowel) complaints, as well as motor and sensory deficits. In a patient with back or leg pain or caudal anesthesia with incontinence or urinary retention, the possibility of cauda equina syndrome must be evaluated immediately because it represents a surgical emergency regardless of etiology. Cauda equina compression is most typically the result of massive central disc herniation, but also can be caused by an epidural abscess, hemorrhage, or tumor.

Causes

• It may be caused by several condition such as including ruptured disk, tumor, infection, fracture or narrowing of the spinal canal.
• Cauda equina syndrome may also occur due to violent impact such as including a car crash, fall from significant height or penetrating injury.
• Penetrating trauma may cause damage or compression of the cauda equina.
• Lumbar disc disease
• Abscess
• Spinal anesthesia
• Tumor, metastatic, or CNS elements

Symptoms

• Low back pain ++++
• Urinary retention or incontinence ++++
• Sciatica may be bilateral
• Lower extremity weakness
• Fecal retention or incontinence
• Saddle anesthesia

Signs

• Urinary retention ++++
• Decreased rectal tone or perianal sensation (anal wink)
• Motor deficit
• Sensory deficit

Treatment

• Treatment options are useful in certain persons, it depend on the underlying cause of the CES. Anti-inflammatory agents, such as including ibuprofen (Advil, Motrin), and corticosteroids, such as including methylprednisolone (Solu-Medrol, Depo-Medrol), may be effective in persons with inflammatory processes, such as including ankylosing spondylitis. In metastatic disease, a focal/local radiation may be considered, especially if surgery is too risky.
• If you have cauda equina syndrome, then you should receive appropriate antibiotic therapy.
• 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.
• You should do rest and drugs to reduce swelling and pain.