CAUDA EQUINA SYNDROME

●INTRODUCTION -

Cauda equina - the peripheral bundle of nerve root originating from the lumbosacral silent of spinal cord. 

●DEFINITION- 

          Cauda  equina syndrome is caused by a significant narrowing of spinal canal that compresses  the spinal cord and causes nerve problems below the level of compression.

●ETIOlOGY-   

1. Central disc herniation

2. Spinal tumours

3. Spinal abscess

4. Meningitis 

5. spinal haematomas/ haemorrhage 

6. spinal trauma with a burst fracture

7. Spondylolisthesis

8. Spinal stenosis 

9. spinal anaesthesia  

10. post operative spinal surgery and complications

11. ankylosing Spondylitis 

12. spinal malformation

●SYMPTOMS -

Bladder disturbance.. 

• Urination different to normal

• Inability to start, stop or control urination 

• Loss of nerve sensation when urination 

• Loss of full bladder sensation 

• Inability to empty bladder fully

Bowel function effect.. 

• Loss of feeling when passing a bowel motion 

• Constipation 

• Loss of control of bowel movement 

          

 Saddle numbness.. 

• Loss of feeling between the legs 

• Numbness in and around the genitals / anus

• Loss of feeling of toilet paper when wiping 

 

Sexual dysfunction.. 

• Loss of sensation during sexual intercourse 

• Inability to achieve an erection or ejaculate 

• Loss of clitoral sensation 

● Low back pain/ leg/weakness and sciatica.. 

A combination of this problem may be present. Keep a look out for bilateral toe extensor/ flexor weakness.  this can occur before other muscle weakness. 

Marked inability to blend forward with back pain /sciatica and leg weakness may indicate a large Disc prolapse anal sphincter reflex may be effected look out for bilateral achilles reflect abscess. 

●INVESTIGATION -

●PHYSICAL EXAMINATION -

1. LMN sign

2. Saddle anesthesia 

3. Sexual, bowel or bladder dysfunction

4. Gait ataxia 

PATHOLOGICAL INVESTIGATION -

1. MRI

2. CTScan

3. AP, lateral, oblique, flexion and extension view x-rays of the lumbosacral spine

4. Urodynamic studies may assess for bladder function subacutely. 

5. Blood – FBC

                 LFT 

                 CRP

●DIFFERENTIAL DIAGNOSIS -

1. Conus medullaris syndrome 

2. Herniated nucleus pulposus

3. Spinal stenosis 

4. Vertebra fracture 

5. Multiple stenosis 

6. Peripheral nauropathy

7. Lumbosacral plexopathy

8. Spinal tumor 

●TREATMENT-

1. MEDICINAL- 

• Treat any underlying cause of compression 

• If infected condition – use antibiotics 

• If inflammatory condition – use anti-inflammatory 

• Pain management 

 

2. SURGICAL TREATMENT -

• Immediate neurosurgeon consulting, surgical decompression may be the only chance to reverse the deficits, which are not always reversible. 

• Malignant disease that is considered inoperable may be treated with radiation therapy and chemotherapy. 

• Ideally the treatment should occurs within the 48hrs after symptoms onset. 

• Spinal immobilization 

• Surgical decompression 

• Drainage 

• Laminectomy

• Fixation of fracture 

• Removal of foreign body

●PREVENTION – 

   

• Control of any predisposing underlying pathology 

• Early diagnosis and treatment are crucial