Cauda Equina Syndrome
En Español (Spanish Version)


Definition
Cauda equina syndrome (CES) occurs when the nerve roots at the base of the spinal cord are compressed. Known as the cauda equina, this bundle of nerves is responsible for the sensation and function of the bladder, bowel, sexual organs, and legs. CES is a medical emergency. If treatment is not started to relieve pressure on the nerves, function below the waist may be lost.

Cauda Equina

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Causes
A common cause of CES is injury of a spinal disk on the nerve roots. A spinal disk is a semi-soft mass of tissue between the bones of the spine. These bones are known as the vertebrae. The disks act as the spine’s shock absorbers. When a disk spills out into the spinal canal, it can press against the bundle of nerves, causing CES. This syndrome may also be caused by:

  • Accident that crushes the spine, such as a car accident or fall
  • Penetrating injury, such as a knife or gunshot wound
  • Arthritis, such as ankylosing spondylitis
  • Complications from spinal anesthesia
  • Mass lesion, such as a blood clot
  • Complications from cancer
  • Side effect of certain medications
Risk Factors
Factors that may increase your risk of developing CES include:

  • History of back problems, such as lumbar spinal stenosis
  • Degenerative disk disease
  • Birth defects, such as a narrow spinal canal or spina bifida
  • Hemorrhages affecting the spinal cord
  • Arteriovenous malformation
  • Spinal surgery or spinal anesthesia
  • Lesion or tumor affecting the spinal bones, spinal nerve roots, or cerebrospinal fluid (CSF)
  • Infection affecting the spine
  • Manipulation of the lower back—rarely
Symptoms
Symptoms may include:

  • Severe low back pain
  • Numbness or tingling in the crotch area known as saddle anesthesia/paresthesia
  • Inability to urinate, or to hold urine or feces
  • Inability to walk or dragging of foot
  • Weakness, loss of sensation, or pain in one or both legs
  • Sexual dysfunction; in men, the inability to maintain an erection
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done. A neurological exam, which includes testing reflexes, vision, mental status, and strength, may also be done. A rectal exam may be done to assess sphincter function.

Images may be taken of your bodily structures. This can be done with:

Your muscle activity may be measured. This can be done with electromyography.

Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:

  • Surgery options:
    • Laminectomy—a surgical procedure to remove a portion of a vertebra, called the lamina
    • Diskectomy—a surgical procedure to remove part of an intervertebral disk that is putting pressure on the spinal cord or nerve root
  • Radiation therapy—If CES is due to cancer, radiation therapy may be an option.
Your doctor may also treat the underlying cause of CES.

Follow-up Care
The long-term effects of CES can range from mild to severe. Problems may include:

  • Difficulty walking
  • Problems with bladder and bowels
  • Sexual dysfunction
  • Paralysis
Your follow-up care may involve working with a:

  • Physical therapist
  • Occupational therapist
  • Neurologist
  • Incontinence specialist—if you have lost bladder control
Medication
Your doctor may prescribe medication for:

  • Pain
  • Bladder and bowel difficulties
Prevention
There is no way to prevent CES.




RESOURCES:
Cauda Equina Syndrome Resource Center

National Spinal Cord Injury Association

CANADIAN RESOURCES:
Canadian Spinal Research Organization

Spinal Cord Injury Canada

References:
Cauda equina syndrome. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00362. Updated October 2007. Accessed November 16, 2013.

Cauda equina syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 8, 2013. Accessed November 16, 2013.

Last Reviewed November 2013



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