Cauda Equina Syndrome

What is Cauda Equina Syndrome?

Cauda equina syndrome is a rare disorder that usually is a surgical emergency. In patients with cauda equina syndrome, something compresses on the spinal nerve roots. You may need fast treatment to prevent lasting damage leading to incontinence and possibly permanent paralysis of the legs.

CES affects a bundle of nerve roots called cauda equina (Latin for horse’s tail). These nerves are located at the lower end of the spinal cord in the lumbosacral spine. They send and receive messages to and from your legs, feet, and pelvic organs.

Causes of Cauda Equina Syndrome

CES occurs more often in adults than in children. But it can occur in children who have a spinal birth defect or have had a spinal injury.

These are the most common causes of cauda equina syndrome:

• A severe ruptured disk in the lumbar area (the most common cause) • Narrowing of the spinal canal (stenosis) • A spinal lesion or malignant tumor • A spinal infection, inflammation, hemorrhage, or fracture • A complication from a severe lumbar spine injury such as a car crash, fall, gunshot, or stabbing • A birth defect such as an abnormal connection between blood vessels (arteriovenous malformation)

Symptoms of Cauda Equina Syndrome

It may be hard to diagnose cauda equina syndrome. Symptoms vary and may come on slowly. They also mimic other conditions. If you have any of these symptoms, see your doctor right away:

• Severe low back pain • Pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair • Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet that is severe or gets worse and worse; you may experience this as trouble feeling anything in the areas of your body that would sit in a saddle (called saddle anesthesia) • Recent problem with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it (incontinence) • Sexual dysfunction that has come on suddenly

How is Cauda Equine Syndrome Diagnosed?

The following tests may be helpful in diagnosing CES:

• Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using magnetic fields and computer technology. MRI produces images of the spinal cord, nerve roots and surrounding areas. • Myleogram: A myleogram is an X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show displacement on the spinal cord or spinal nerves due to herniated discs, bone spurs, tumors, etc.

Treatment of Cauda Equina Syndrome

If you have cauda equina syndrome, you’ll need prompt treatment to relieve pressure on nerves. Surgery must be done quickly to prevent permanent damage, such as paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems. It is best if this occurs within 48 hours of the onset of symptoms. Depending on the cause of your CES, you may also need high doses of corticosteroids. These can reduce swelling. If you are diagnosed with an infection you may need antibiotics. If a tumor is responsible, radiation or chemotherapy may be needed after surgery.

Even with treatment, you may not retrieve full function. It depends on how much damage has occurred. If surgery is successful, you may continue to recover bladder and bowel function over a period of years.