Cauda Equina Syndrome Symptoms
Cauda Equina Syndrome, although uncommon, is a serous spine disorder. It is the result of compression of the Cauda Equina nerves, which are a bundle of nerves at the end of the spinal cord. The spinal cord ends between the L1 and L2 vertebral levels as a tapered structure called the conus medullaris (around the same level as your kidneys). Below the conus medullaris, nerves continue to extend down inside the spinal column in a group named the cauda equina (latin for horse's tail). The cauda equina includes the nerve roots of L2 to L5 and all the sacral and coccygeal nerves.
What Causes Cauda Equina Syndrome
Cauda Equina Syndrome results from compression or swelling of the nerve roots of the cauda equina. This is usually due to conditions such as:
- A severe ruptured spinal disc in the lumbar area (the most common cause)
- Spinal tumour
- Narrowing of the spinal canal (stenosis)
- Infection or inflammation
- Fracture, dislocation or haematoma (trauma)
- Birth defect
Cauda Equina Syndrome is rare but has serious consequences and can cause devastating long-lasting neurological deficits. Prompt evaluation and urgent Magnetic Resonance Imaging assessment should be performed in all patients who present with back pain in conjunction with sudden onset of urinary or bowel symptoms or abnormal neurological findings consistent with cauda equina involvement.
Symptoms of Cauda Equina Syndrome:
- Low back pain
- Unilateral or bilateral sciatica
- Saddle hypaesthesia or anaesthesia
- Bowel and bladder disturbances. Typically, urinary manifestations begin with urinary retention and are later followed by overflow urinary incontinence.
- Lower extremity motor weakness and sensory deficits
- Reduced or absent lower extremity reflexes
The onset of Cauda Equina Syndrome can be either sudden (acute) within 24 hours or gradual over a period of weeks or months.
If patients with cauda equina syndrome do not receive treatment quickly, adverse results such as paralysis, impaired bladder, and/or bowel control, difficulty walking, and/or other neurological and physical problems can quickly arise. It is imperative to seek professional advice immediately if you are experiencing any of the above symptoms.
However, patients should be aware that acute cauda equina syndrome that results in permanent nerve damage is extremely rare.
Diagnosis and Treatment of Cauda Equina Syndrome
Cauda Equina Syndrome is diagnosed through an understanding of the patients history, physical examination, and medical imaging such as MRI, CT scans, and/or a myelogram.
Once diagnosed, Cauda Equina Syndrome is considered a medical emergency requiring immediate surgery to prevent permanent damage. Often the patient will require medication such as steroids to control inflammation, or antibiotics for an infection. The long term prognosis depends on a variety of factors, specifically how quickly surgery was performed after the onset of symptoms.
While it is generally thought that neurological damage caused by cauda equina syndrome is permanent, some studies have reported that long-term management may allow patients with initially poor prognosis following surgery to eventually regain a near-normal voiding of a bladder with little daily interruption.
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