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CAUDA EQUINA SYNDROME

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CAUDA EQUINA SYNDROME

Cauda equine syndrome refers to a condition that occurs when the bundle of nerve roots that spreads out at the base of the spinal cord become compressed (squeezed together), or damage, cutting off sensation and movement.

  • This bundle of nerve roots are referred to as the cauda equina and are horse-like in appearance.
  • The cauda equina is made up of 10 fiber pairs at its base which includes three to five lumbar fiber pairs, fiver sacral fiber pairs, and one coccygeal nerve.
  • The basic function of the cauda equina is to send and receive messages to and from the pelvic organs (which is made up of the bladder, rectum, and the internal genital organs) and the lower limb.
  • This condition is considered serious and an emergency required medical condition.
  • If patients with this condition do not seek immediate medical care to relieve pressure, they may permanently lose the functions of their bowel and bladder and can lead to permanent paralysis of the legs, loss of sexual sensation, and other problems
  • About 1 in 700,000 people are affected per year.
  • The condition is prevalent in adults, although trauma-related cauda equina syndrome can affect people of all ages.

CAUSES

The most cause of cauda equina syndrome is caused by a herniated disk in the lumbar spine. In most people, the disc herniation occurs in the L4-5 or L5-S1 discs in the lumbar spine. A herniated disk may be caused by a single excessive stress or trauma. However, as a person ages, disc material degenerates, weakening the ligaments that hold it together. As this degeneration progresses, a minor movement or strain can the disc to rupture.

Other causes include:

  • Birth abnormalities
  • Spinal lesions and tumors
  • Lumbar spinal stenosis
  • Chronic spinal inflammations such as ankylosing spondylitis, Paget disease, neurosarcoidosis, chronic tuberculosis.
  • Infections
  • Spinal anesthesia
  • Iatrogenic lumbar punctures
  • Trauma to the lower back such as knife wounds, gunshots, vehicle accidents
  • Spinal hemorrhage
  • Complications from lumbar spine surgery

SYMPTOMS

Symptoms may vary in intensity and may evolve slowly over time depending on the severity of the compression and the precise nerve roots that are involved.

The following are symptoms associated with the condition:

  • Severe low back pain
  • Sexual dysfunction
  • A weakness of the muscles of the lower legs
  • Bladder dysfunction, causing you to retain urine (urinary retention) or to not be able to hold it (urinary incontinence).
  • Saddle anesthesia (numbness around the inner thigh and the groin, the saddle area).
  • Sensory loss, motor weakness, or pain in one or both legs.
  • Achilles reflex absent on both side
  • Gait disturbances

Severe back pain, saddle anesthesia, incontinence, and sexual dysfunction are considered ad red flags.

DIAGNOSIS AND TREATMENT

To make a diagnosis, the doctor will review your medical history and carry out a physical examination. During the physical examination, the doctor will ask you to stand, sit, walk on your heel and toes, bend forward and backward on your side, and ask you to lift your leg while lying down. This is done to assess strength, reflexes, stability, alignment, and motion.

Imaging studies may also be carried out such as:

  • MRI scan to produce the images of the spinal cord, nerves root, and the surrounding areas.
  • Myelogram
TREATMENT

Once cauda equine is diagnosed, urgent surgery is carried out to reverse the symptoms. This is always the best choice of treatment. Surgery may be used to remove a herniated disk, tumors, blood, bone fragments or any abnormal growth

If your syndrome is caused by inflammation, anti-inflammatory including steroids may be effective.

antibiotics may be effective if a bacterial infection is causing the condition.