What is Cauda equina Syndrome (CES)?Treatment, Related Questions

In the lumbar and sacral regions,  cauda equina is continuation of nerve roots. These nerves communicate with the lower limbs and pelvic organs by sending and receiving messages. Multiple lumbar and sacral nerve roots of the cauda equina become dysfunctional, resulting in cauda equina syndrome (CES).

 

Causes

A large herniated disc in the lumbar area is the most typical cause of CES. A herniated disc can be caused by a single extreme strain or injury, but many disc herniations do not have a known etiology.

Potential Causes of CES

· 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 (subarachnoid,subdural,epidural)

· Postoperative lumbar spine surgery complications

· Spinal anesthesia

Symptoms

Patients with CES 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. 

·“Saddle anesthesia” 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 lower extremities. 

·Pain in the back and/or legs (also known as sciatica).

· Sexual dysfunction.

Diagnosis

Tests that May be Helpful in Diagnosing CES

· Patient history and physical exam: Extremely important to assess for cauda equina syndrome. 

· Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using magnetic fields and computer technology. MRI produces images of the spinal cord, nerve roots and surrounding structures.

· CT Scan: If CES is secondary to bone collapse from trauma or cancer, this study can help define that. Visualization of the discs are not as easily seen on CT scan. If no MRI is available, this study can give information helpful to evaluate the anatomy of the region, particularly if done in combination with a myelogram described below. 

· Myleogram: : An X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show displacement on the spinal cord or spinal nerves due to herniated discs, bone spurs, tumors, etc.

Treatment

Depending on the underlying etiology of cauda equina syndrome, medical therapy options may be beneficial to certain people. In persons with inflammatory conditions, such as ankylosing spondylitis, anti-inflammatory drugs including ibuprofen(Advil,Motrin) and corticosteroid like methylprednisolone can help.

Antibiotics should be given to people who have cauda equina syndrome caused by an infection. Chemotherapy and radiation therapy should be considered for those with spinal tumors (neoplasms).

If you have cauda equina syndrome and are experiencing groin numbness (saddle anesthesia), weakness in both legs, or loss of bowel or bladder control, don't wait more than 24 hours to seek medical help. If symptoms do not improve within this time, urgent surgical decompression is frequently suggested to reduce the risk of irreversible nerve harm.

What is the first signs of cauda equina?

The most common initial symptom of people with cauda equina syndrome caused by a tumor (spinal neoplasm) is severe low back and leg pain. Later findings include lower extremity weakness. Loss of feeling in the legs (sensory loss) and loss of bowel or bladder control (sphincter dysfunction) are also common.

 

How do you fix cauda equina syndrome?

Cauda equina syndrome is best treated with decompression by a lumbar laminectomy, but a lumbar microdiscectomy may be used given a patient's unique situation. The patient will likely be kept in the hospital for a few days following the surgery to monitor recovery of motor and sensory function.

 

Is walking good for cauda equina syndrome?

Pelvic floor exercises can assist with regaining bladder control and gentle aerobic exercise such as walking can help restore strength in the lower back and legs.

What levels cause cauda equina syndrome?

Cauda equina syndrome (CES) results from compression and disruption of the function of these nerves and can be inclusive of the conus medullaris or distal to it, and most often occurs when damage occurs to the L3-L5 nerve roots.