What Is Cauda Equina Syndrome? Symptoms & Treatment

The Cauda Equina refers to a bundle of nerves that branch away from the end of the spinal cord in the lower back, located in the lumbrosacral spine the nerves are responsible for sending and receiving messages to and from the legs, feet and pelvic organs.

The name Cauda Equina literally translates from Latin as horse tail, due to the physical appearance of the nerves, reminiscent of a horse’s tail as they extend away from the spinal cord down into the legs. Cauda Equina Syndrome (CES) describes an extremely serious condition that occurs when the Cauda Equina is suddenly compressed. It requires emergency surgery to relieve the pressure, if left untreated, permanent paralysis of the legs, plus loss of bladder and bowel control can occur.

Symptoms

The symptoms of CES can present themselves suddenly or more gradually.

Red flags for CES typically include one or more of the following:

Lower back pain – localised pain felt at the source of the compression

Bilateral leg pain – radiating pain, resulting from the compression of the nerve roots, often described as sharp stabbing pains running through the legs

Saddle anaesthesia – sensory loss in the perineal region, in the buttocks (numbness may also be felt through the legs and or, a lack of normal reflexes)

Bladder dysfunction – loss of control and function over bladder movements, resulting in urinary incontinence or retention

Bowel dysfunction – loss of control and function of bowel movements, the inability to stop or feel bowel movement, or severe constipation

Sexual dysfunction – loss of ability to perform and or, loss of sensations during intercourse

Causes Of CES

The is a rare condition, found more commonly in adults than in children, in some unusual cases it may occur in children with spinal birth defects.

Herniated disc

The most prevalent cause of CES is a severely ruptured lumbar disc. Our vertebrae are separated by intervertebral discs, these act as shock absorbers, preventing the vertebrae from grinding against one another, as well as cushioning them from the knocks and bumps of daily physical activity. Each disc comprises of a tough fibrous outer layer, the annulus fibrosis, protecting its soft inner centre, the nucleus puloposus.

Degenerative ageing processes and trauma can, on occasions, cause the outer layer of the disc to tear or rupture, allowing the soft inner centre to seep out of the crack and encroach on any nearby soft tissue. This can occur at any point along the spinal column; in many cases patients are not even aware they have a herniated disc, as there may be no symptoms. However, when disc material comes into contact with exiting nerve roots, this can cause considerable pain and discomfort. These symptoms will usually resolve themselves over time as the disc naturally repairs itself, and no long term damage will occur. In the case of CES a severely ruptured disc occurs in the lumbar area (lower back) where the cauda equina nerves are located, a large amount of disc material crushes the nerves, preventing them from transmitting and receiving signals from the spinal cord to the pelvic organs, legs and feet.

Spinal Stenosis

This refers to the narrowing of the passageway where the spinal cord is located, known as the spinal canal. When narrowing occurs, it can compress nearby nerves exiting from the spinal cord, or the actual spinal cord itself, causing a range of symptoms depending on where the compression occurs. If it occurs in the lumbrosacral spine, it can cause CES. Spinal stenosis can materialise as a result of degenerative conditions, such as degenerative disc disease, or due to an abnormal growth such as a tumour.

Spondylolisthesis

This condition occurs when one of the vertebrae slips out of place, if this happens to a vertebrae in the lumbrosacral spine, it may in an extreme case, crush the cauda equina nerves causing CES.

Other Possible Causes

  • Malignant tumours or lesions within the lumbrosacral spine
  • Inflammatory conditions
  • Infection
  • Trauma where severe damage to the lumbrosacral spinal region occurs in an accident, (car crash, fall etc.) or a wound from a gunshot or stabbing.
  • Birth defect – where there is an abnormal connection between blood vessels
  • Accidental cause by medical intervention, secondary effect of spinal treatment such as poorly positioned screws in the spine during spinal surgery.

Diagnosis

CES can be problematic to diagnose as it may mimic symptoms of other conditions; for example, numbness in the buttocks and legs, and shooting pains down the legs, are common symptoms of sciatica. However, any present red flags for CES should be investigated immediately.

A thorough medical examination that includes a detailed medical history of the patient, plus a physical examination will be required. Further investigation will be needed in order to confirm the diagnosis, with the use of an MRI or an XRAY myelogram with a CT scan.

Treatment

The success of any treatment will depend on the cause of CES and how quickly treatment was provided. Surgery is indicated to relieve the pressure on the nerves from a herniated disc, abnormal bone growth, or to remove a tumour. It is vital that the surgery should be carried out as a priority medical emergency to try and prevent any permanent damage from occurring.

Treatment may vary depending on the cause of the condition; in the case of malignant tumours, radiotherapy or chemotherapy may be necessary, strong antibiotics for infection or a high dose of corticosteroids for inflammatory conditions.

The prognosis for CES very much depends on the extent and severity of the nerve compression and how quickly decompression was carried out. Post surgery recovery will vary from patient to patient, continuing bladder, bowel and sexual problems are likely to depend on the severity and duration of the symptoms pre-surgery.

Living With Cauda Equina Syndrome

cauda equina syndromeIt is vital that CES is diagnosed quickly and treated immediately, if treatment is delayed and permanent damage does occur, the patient will have to adapt to a life changing condition. A strong support network is vital for the physical and psychological changes the patient will suffer. A pain management clinic can be extremely beneficial for those suffering from CES, as it provides a multidisciplinary team of health professionals with specialised training in the area of pain management. Many pain clinicians understand chronic pain using the biopsychosocial model, this assumes that the biological (physical condition) psychological (emotions, thoughts and behaviour) and social (socio economic and socio-environmental) should all be taken into consideration when determining any individual’s state of health and their necessary treatment.

Patients suffering with chronic CES will inevitably suffer from physical limitations, such as chronic pain, disturbed bladder and bowel functions and sexual problems. Another difficulty that patients face is that their symptoms, although severe, may be invisible to the outside world and difficult to address as they involve highly personal bodily functions. A pain management program can help patients manage their symptoms through medication and physiotherapy, as well as the much needed psychological support to help patients adapt to, and accept their condition. Support from family and friends is essential and there are also a number of support groups and forums in the UK available for patients to share their experiences.

Nerve Pain

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Back Pain

back pain

Treatments

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