WHAT IS CAUDA EQUINA SYNDROME?
Cauda equina means horse’s tail and it describes the nerves found at the end of the spinal cord, which resemble the tail of a horse. Cauda equina syndrome is a disorder affecting these nerves. Both sensory and motor nerve fibers can be affected causing problems in the sacral region and legs.
What is cauda equina syndrome?
Cauda equina syndrome (CES syndrome) is when there is damage to the specific nerves called collectively the cauda equina. Cauda equina compression is the usual problem here where the caudal nerves are squeezed.
How rare is cauda equina syndrome?
CES is uncommon with prevalence in the general population varying from about 1 in 32,000 to 1 in 100,000 people.
Where is the cauda equina?
These nerves actually radiate out from the end of the spinal cord. The roots of the cauda equina nerves are found from the second lumbar vertebra to the first coccyx vertebra. The nerves radiate out and downwards branching further into smaller nerves that innervate structures in the pelvis and legs. The cauda equina nerves project from a part of the spinal cord called the conus medullaris
Conus medullaris vs cauda equina
The conus medullaris is a section of the spinal cord that is in the shape of a cone. Conus medullaris syndrome is another disorder that can occur which is similar to cauda equina. Conus medullaris problems happen when there is damage higher up the cord between the 12th thoracic vertebra and 2nd lumbar vertebra.
Symptoms of conus medullaris syndrome include:
- Severe pain in the back
- Odd sensations such as tingling in the back and legs
What causes cauda equina syndrome?
Cauda equina syndrome causes include factors that result in the spinal nerves being compromised in some way. The causes of the syndrome are described below.
- Herniated disk: This is when part of the cartilaginous tissue making up the disk bulges outwards impacting the nerves.
- Spinal stenosis: Stenosis is when there is a narrowing and, in this case, it is a narrowing of the space surrounding the spinal cord.
- Spina bifida: This is a congenital problem in which there is a problem in how the spinal cord has developed.
- Spinal cord infection: Diskitis is when there is inflammation in the space between the vertebrae.
- Tumor on the spine: A tumor can form in the tissue surrounding the spine, putting pressure on the lower nerves of the cord.
- Traumatic injury to the lumbar region: An accident can damage the structures and nerves of the spinal area.
- Inflammatory demyelinating polyneuropathy: This is a type of polyneuropathy that can lead to cauda equina syndrome.
Cauda equina syndrome symptoms
Cauda equina symptoms involve the pelvic region and legs and include a lack of strength in the legs and numbness in all the areas served by the caudal nerves.
What are the first signs of cauda equina syndrome?
Early symptoms of cauda equina syndrome are given below.
- Saddle paresthesia: This is a tingling and numb sensation in the groin, thighs, and buttocks.
- Saddle anesthesia: This is a classic symptom of the condition and is when there is a loss of feeling in the parts of the body that would make contact with a saddle if you were sitting on one.
- Loss of feeling and weakness in the legs: Damage to the cauda equina nerves can mean that signals from the legs do not pass easily up the spinal cord. Numbness is a common symptom of many spine degeneration problems.
- Bowel incontinence: The tone of the anal sphincter can be lost causing fecal leakage.
- Bladder incontinence: The bladder overfills with urine causing leakage.
- Retention of urine: The person has no sense that they need to urinate due to a loss of sensation.
Additional symptoms of cauda equina syndrome are as follows:
- Sciatica: Pain that begins in the lower back and extends down into one or both legs.
- Sharp lower back pain: This can occur due to inflammation in the area of the back where a disk is bulging out.
- Inability to walk: This is because the motor function of the nerves is compromised.
- Reduced reflexes: The interruption in nerve signals means that messages cannot get through to the section of the spinal cord where reflexes are generated.
Cauda equina syndrome diagnosis
It is important for doctors to determine if a patient has cauda equina vs conus medullaris. This can be achieved through careful diagnostic testing.
To diagnose cauda equina syndrome, imaging methods are required. Cauda equina diagnosis methods are given below.
- Magnetic resonance imaging (MRI): This is a good technique for diagnosing CES since it shows fine details, including soft tissues.
- Computer tomography (CT): This scan can show the bones and also how big the space surrounding the spinal cord is.
- Myelogram: This is an X-ray of the spine after a contrast dye has been injected into the body. This can show if nerves are being pinched.
Does cauda equina syndrome go away?
This condition cannot go away on its own. Living with cauda equina syndrome is difficult especially since it is likely to lead to total incontinence and paralysis. Without treatment complications are likely.
What is the treatment for cauda equina syndrome?
Cauda equina treatment depends on the exact reason for the condition.
- Lumbar laminectomy: A piece of the vertebra is surgically cut out to provide more room for the nerves that are being pinched due to a problem with the vertebra.
- Microdiscectomy: This procedure is needed when the cauda equina nerves are compressed because of a bulging disk. The bulging section of the cartilage disk is cut out and pressure is taken off of the nerves.
- Surgery, chemotherapy, and radiation: Tumors of the spine can be primary or metastatic cancer. Surgery along with radiation and chemotherapy may be used for treatment.
Cauda equina syndrome needs to be diagnosed and distinguished from conus medullaris syndrome. Diagnosis needs to be done before further damage is caused. Cauda equina syndrome treatment needs to be started as soon as possible. Cauda equina syndrome recovery depends on how advanced the condition is, which is why patients need to be treated rapidly.
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Dr. Rae Osborn has a Ph.D. in Biology from the University of Texas at Arlington. She was a tenured Associate Professor of Biology at Northwestern State University where she taught many courses for Pre-nursing and Pre-medical students. She has written extensively on medical conditions and healthy lifestyle topics, including nutrition. She is from South Africa but lived and taught in the United States for 18 years.
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- Lee, S. E., Park, S. W., Ha, S. Y., & Nam, T. K. (2014). A case of cauda equina syndrome in early-onset chronic inflammatory demyelinating polyneuropathy clinically similar to Charcot-Marie-Tooth disease type 1. Journal of Korean Neurosurgical Society, 55(6), 370-374. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166336/
- Qureshi, A., & Sell, P. (2007). Cauda equina syndrome treated by surgical decompression: the influence of timing on surgical outcome. European Spine Journal, 16(12), 2143-2151. https://link.springer.com/article/10.1007/s00586-007-0491-y
- Rider, L. S., & Marra, E. M. (2021). Cauda equina and conus medullaris syndromes. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537200/
- Rubin, M. (2021). Cauda Equina Syndrome. https://www.msdmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/cauda-equina-syndrome
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