Cauda Equina Syndrome

Cauda Equina is the anatomic term for the collection of nerves at the end of the spinal cord, which ends at the upper portion of the lumbar spine. These nerve roots innervate the legs and the bladder, and cauda equina is the continuation of these nerve roots in the lumbar region.

Cauda Equina Syndrome (CES) is one of the causes of low back pain that affects millions of people every year. Cauda Equina Syndrome is characterized by compression of the nerve roots that disrupts motor and sensory function to the lower extremities and bladder and resulting in severe lower back pain. In extreme cases, it can lead to incontinence and even permanent paralysis.

CES primarily occurs in adults, but trauma-related CES can affect people of all ages. In a small number of patients, it occurs as a post-surgical complication after the herniated lumbar disc repair. The most common cause of CES is a major lumbar disc herniation. Other causes include spinal lesions, tumors, infections, inflammation, stenosis, traumatic injuries to the lower back, congenital abnormalities, vascular malformations, hemorrhages, post-surgical complications, spinal anesthesia, etc.

CES can be difficult to diagnose because its symptoms mimic those of other conditions and vary quite a bit. The severity of these symptoms depends on the degree of compression and the precise nerve roots being compressed. The most concerning clinical features of CES are severe low back pain, motor/sensory weakness,
leg pain, saddle anesthesia, urinary retention/incontinence, bowel incontinence, sexual dysfunction, etc.

Once there is a clinical concern, CES may be diagnosed using magnetic resonance imaging (MRI) of the spine to evaluate the spinal cord, nerve roots, and surrounding areas. A myelogram could also be performed, which is essentially an X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid space, and it can reveal displacement on the spinal cord or spinal nerves due to herniated discs, bone spurs, or tumors.

CES requires urgent surgery in order to reverse the neurological damage and to prevent further loss of neural function. If left untreated, CES can result in permanent paralysis and incontinence. If treated within 48 hours after the onset of the warning signs, there is a good chance of improving neurological deficits, including sensory/motor deficits as well as urinary and rectal dysfunction. After corrective surgery, the symptoms may continue to improve for years after surgery. Bladder function can improve considerably with the help of medication and intermittent self-catheterization.

Chronic CES has a huge physical and emotional impact on patients. There is a severe disability and personal as well as social life is majorly affected. Daily function is severely compromised because of the pain and other neurological symptoms. Sexual dysfunction can be devastating in and of itself, all of that can lead to depression. Therefore, it is essential that people with CES receive an early and accurate diagnosis, prompt treatment, adequate rehabilitation, and emotional support to have the best possible shot at recovery.