Cauda Equina Syndrome
Cauda equina is the stretch of nerve roots that extend from the second lumbar space straight up to beyond the conus. Cauda equina is termed as such because these nerve roots bear a big resemblance to the horse of a tail. Cauda equina syndrome, from the name itself, is a neurologic condition that specifically affects the said nerve roots. It is a much infrequent disease that usually manifests with severe low back pain. More often than not, a speedy surgical intervention should be done as soon as possible because this disease condition is considered as a medical emergency.
A person’s spinal cord is a very essential yet delicate part of the body in order to utilize its optimum functionality. That is why when something is wrong with it, fast medical attention and intervention should be rendered. Specifically, cauda equina syndrome takes place when a nerve compression is present. This nerve compression can manifest a lot of damaging effects such as paralysis of the lower limbs and urinary incontinence among others.
These clinical manifestations affect the lower region of the body because these groups of nerves where the compression occurs are the primary nerves responsible for sending and receiving nerve signals going and back to the feet, legs and the pelvic organs as well. In addition, the damages brought about by cauda equina syndrome have a high probability of being an irreversible damage. This possibility of an irreversible damage is also one of the reasons why cauda equina syndrome is considered as a surgical emergency.
Picture : Cauda Equina
Image source : ADAM Inc
Cauda Equina Syndrome Causes
Cauda equina syndrome is more often than not prevalent in adults than in children. However, cauda equina syndrome can possibly come about in children due to some reasons such as spinal defects at birth among others. The most common causes are listed in the following bullets. So here goes:
- Lesions – Lesions that cause nerve compression to the nerve roots encompassing the cauda equina can precipitate cauda equina syndrome. The most common of which is the prolapse of the central disc.
- Trauma – Knife and ballistic trauma are one of these causes. Another of which is direct trauma brought about by lumbar punctures such as in spinal anesthesia.
- Narrowing of the lumbar spine – This narrowing of the lumbar spine is medically referred to as lumbar spine stenosis.
- Tumors – Both of the metastatic and primary tumor types can cause cauda equina syndrome.
- Inflammation – Inflammatory conditions can possibly cause the narrowing of the lumbar spine; hence, cauda equina syndrome can result.
- Birth defects – Spinal birth defects can also cause cauda equina syndrome in children.
- Idiopathic – Idiopathic causes are unknown causes of the cauna equina syndrome.
Cauda Equina Syndrome Symptoms
Cauda equina syndrome symptoms may show discrepancy among cases. However, cauda equina syndrome symptoms usually involve abnormalities in the lower region of the body; specifically, the feet, legs and the organs of the pelvic. The common cauda equina syndrome symptoms are listed below:
- Severe pain in the lower back
- Muscle weakness of the lower limbs
- Urinary retention due to weakness of the sphincter
- Urinary incontinence
- Fecal incontinence
- Absence of ankle reflex on both legs
- Pain on both legs
- Sexual dysfunction
Cauda Equina Syndrome Diagnosis
In the process of diagnosing cauda equina syndrome, a lot of confirmatory diagnostic tools are being employed. First off, a comprehensive assessment is done encompassing the patient’s past medical history and physical condition of the body. Oftentimes, a blood test is also done to aid diagnosis. Lastly, the patient may undergo various imaging studies or exams such as the magnetic resonance imaging or MRI, computed tomography scan or CT scan, ultrasonography and a myelogram among others.
Cauda Equina Syndrome Treatment
Since as mentioned earlier, cauda equina syndrome is a medical emergency requiring immediate surgical intervention; then more often than not, a surgical intervention is primarily done. The surgical intervention usually employed is the surgical decompression by way of laminectomy among others. In addition, this surgical decompression can have high probabilities of achieving positive results if done within 48 hours upon onset of cauda equina syndrome symptoms. Additionally, immobilization is one of the managements of cauda equina syndrome when trauma is the cause of the disease.
Cauda Equina Syndrome Surgery
As mentioned above, cauda equina syndrome is treated through employing surgical techniques such as surgical decompression. This surgical decompression is usually done by employing the laminectomy technique. Laminectomy is done by getting rid of some structures over the spinal cord and spinal nerves. These structures are the whole bony lamina, part of the facet joints and lastly, the ligaments that are already thickened.
Cauda Equina Syndrome Prognosis
The prognosis of cauda equina syndrome is determined depending on a lot of factors such as the severity of the nerve compression, the length of time between the onset of cauda equina syndrome symptoms and the time the surgical decompression is done. However, the general rule that is followed in determining the prognosis of cauda equina syndrome is that the longer the time it takes to seek surgical intervention, the more damage is caused.