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Cauda equina syndrome
 
 
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Cauda equina syndrome is a serious neurologic
Neurology

Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the Central nervous system, Peripheral nervous system, and autonomic nervous systems, including their coverings, blood vessels, and...
 condition in which there is acute loss of function of the neurologic elements (nerve root
Nerve root

A nerve root is the initial segment of a nerve leaving the central nervous system. Types include:* A cranial nerves root, the beginning of one of the eleven pairs leaving the central nervous system from the brain stem or the highest levels of the spinal cord;...
s) of the spinal canal below the termination (conus
Conus medullaris

The conus medullaris is the terminal end of the spinal cord. It occurs near lumbar nerves 1 and 2 . After the spinal cord tapers out, the spinal nerves continue as dangling nerve roots....
) of the spinal cord.

r the conus the canal contains a mass of nerves (the cauda equina
Cauda equina

The cauda equina is a structure within the lower end of the spine of most vertebrates, that consists of nerve roots and rootlets from above. The space in which the cerebrospinal fluid is present is actually an extension of the subarachnoid space....
 or "horse-tail" branches off the lower end of the spinal cord and contains the nerve roots from L1-5 and S1-5. The nerve roots from L4-S4 join in the sacral plexus which affects the sciatic nerve ) which travels caudally (toward the feet).

Any lesion which compresses or disturbs the function of the cauda equina may disable the nerves although the most common is a central disc prolapse.

Metastatic disease should be suspected in every patient with weight loss and cauda equina syndrome.

s include weakness of the muscles innervated by the compressed roots (often paraplegia
Paraplegia

Paraplegia is an impairment in motor and/or sensory function of the lower extremities. It is usually the result of spinal cord injury or a congenital condition such as spina bifida which affects the neural elements of the spinal canal....
), sphincter weaknesses causing urinary
Urine

Urine is a liquid waste product of the body secreted by the kidneys by a process of filtration from blood called urination and excreted through the urethra....
 retention and post-void residual incontinence
Incontinence

Incontinence, involuntary discharge of urine or feces, may refer to:*Fecal incontinence, the inability to control one's bowels*Urinary incontinence, the involuntary excretion of urine...
 as assessed by catheterizing after the patient has voided. Also, there may be decreased rectal
Rectum

The rectum is the final straight portion of the large intestine in some mammals, and the Gastrointestinal tract in others, terminating in the anus....
 tone; sexual dysfunction
Sexual dysfunction

Sexual dysfunction or sexual malfunction is difficulty during any stage of the sexual act that prevents the individual or couple from enjoying sexual activity....
; saddle anesthesia
Saddle anesthesia

Saddle anaesthesia is a loss of sensation restricted to the area of the buttocks and perineum.It is frequently associated with cauda equina syndrome....
; bilateral leg
Leg

Leg may refer to the following places in Poland:*A former name for the town of Elk *Leg, Lower Silesian Voivodeship *Leg, Kuyavian-Pomeranian Voivodeship ...
 pain
Pain

Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm....
 and weakness; and bilateral absence of ankle reflexes.






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Encyclopedia


Cauda equina syndrome is a serious neurologic
Neurology

Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the Central nervous system, Peripheral nervous system, and autonomic nervous systems, including their coverings, blood vessels, and...
 condition in which there is acute loss of function of the neurologic elements (nerve root
Nerve root

A nerve root is the initial segment of a nerve leaving the central nervous system. Types include:* A cranial nerves root, the beginning of one of the eleven pairs leaving the central nervous system from the brain stem or the highest levels of the spinal cord;...
s) of the spinal canal below the termination (conus
Conus medullaris

The conus medullaris is the terminal end of the spinal cord. It occurs near lumbar nerves 1 and 2 . After the spinal cord tapers out, the spinal nerves continue as dangling nerve roots....
) of the spinal cord.

Causes

After the conus the canal contains a mass of nerves (the cauda equina
Cauda equina

The cauda equina is a structure within the lower end of the spine of most vertebrates, that consists of nerve roots and rootlets from above. The space in which the cerebrospinal fluid is present is actually an extension of the subarachnoid space....
 or "horse-tail" branches off the lower end of the spinal cord and contains the nerve roots from L1-5 and S1-5. The nerve roots from L4-S4 join in the sacral plexus which affects the sciatic nerve ) which travels caudally (toward the feet).

Any lesion which compresses or disturbs the function of the cauda equina may disable the nerves although the most common is a central disc prolapse.

Metastatic disease should be suspected in every patient with weight loss and cauda equina syndrome.

Signs

Signs include weakness of the muscles innervated by the compressed roots (often paraplegia
Paraplegia

Paraplegia is an impairment in motor and/or sensory function of the lower extremities. It is usually the result of spinal cord injury or a congenital condition such as spina bifida which affects the neural elements of the spinal canal....
), sphincter weaknesses causing urinary
Urine

Urine is a liquid waste product of the body secreted by the kidneys by a process of filtration from blood called urination and excreted through the urethra....
 retention and post-void residual incontinence
Incontinence

Incontinence, involuntary discharge of urine or feces, may refer to:*Fecal incontinence, the inability to control one's bowels*Urinary incontinence, the involuntary excretion of urine...
 as assessed by catheterizing after the patient has voided. Also, there may be decreased rectal
Rectum

The rectum is the final straight portion of the large intestine in some mammals, and the Gastrointestinal tract in others, terminating in the anus....
 tone; sexual dysfunction
Sexual dysfunction

Sexual dysfunction or sexual malfunction is difficulty during any stage of the sexual act that prevents the individual or couple from enjoying sexual activity....
; saddle anesthesia
Saddle anesthesia

Saddle anaesthesia is a loss of sensation restricted to the area of the buttocks and perineum.It is frequently associated with cauda equina syndrome....
; bilateral leg
Leg

Leg may refer to the following places in Poland:*A former name for the town of Elk *Leg, Lower Silesian Voivodeship *Leg, Kuyavian-Pomeranian Voivodeship ...
 pain
Pain

Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm....
 and weakness; and bilateral absence of ankle reflexes. Pain may, however, be wholly absent; the patient may complain only of lack of bladder control and of saddle-anaesthesia, and may walk into the consulting-room.

Diagnosis is usually confirmed by an MRI scan or CT scan, depending on availability. If cauda equina syndrome exists, surgery is an option depending on the etiology discovered and the patient's candidacy for major spine surgery.

Treatment/management

The management of true cauda equina syndrome frequently involves surgical decompression.

Cauda equina syndrome of sudden onset is regarded as a medical emergency. Surgical decompression by means of laminectomy or other approaches may be undertaken within 48 hours of symptoms developing if a compressive lesion, e.g. ruptured disc, epidural abscess, tumor or hematoma is demonstrated. This treatment may significantly improve the chance that long-term neurological damage will be avoided. There are, however, no evidence-based medical standards that address the question of ultra-early versus delayed (48 hours) surgical decompression in cauda equina syndrome due to ruptured lumbar disc.

Prognosis

The prognosis for complete recovery is dependent upon many factors. The most important of these factors is the severity and duration of compression upon the damaged nerve(s). As a general rule the longer the interval of time before intervention to remove the compression causing nerve damage the greater the damage caused to the nerve(s).

Damage can be so severe and/or prolonged that nerve regrowth is impossible. In such cases the nerve damage will be permanent. In cases where the nerve(s) has been damaged but is still capable of regrowth, recovery time is widely variable. Quick surgical intervention can lead to complete recovery almost immediately afterward. Delayed or severe nerve damage can mean up to several years recovery time because nerve growth is exceptionally slow.

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