Cauda equina syndrome

Cauda equina syndrome
Synonyms
Pronounce
Field	Neurosurgery, orthopedics
Symptoms	Low back pain, pain that radiates down the leg, numbness around the anus, loss of bowel or bladder control
Complications
Onset	Rapid or gradual
Duration
Types
Causes	Disc herniation, spinal stenosis, cancer, trauma, epidural abscess, epidural hematoma
Risks
Diagnosis	Medical imaging (MRI, CT scan)
Differential diagnosis
Prevention
Treatment	Surgery (laminectomy)
Medication
Prognosis	20% risk of poor outcome
Frequency	1 in 70,000 a year
Deaths

Approximate area of "saddle anesthesia" seen from behind (yellow highlight)

Cauda equina syndrome (CES) is a serious neurologic condition that arises due to the damage of the cauda equina, a collection of spinal nerves and nerve roots at the lower end of the spinal cord.<ref name=NIH2015>

Cauda equina syndrome(link). Genetic and Rare Diseases Information Center (GARD).

2015.

</ref> The syndrome presents with a range of symptoms including low back pain, leg pain, numbness around the anus, and loss of bowel or bladder control.<ref name=Gar2011/> The onset of symptoms can either be rapid or gradual.<ref name=Gar2011/>

Causes and Diagnosis

CES most commonly results from a disc herniation in the lower region of the back.<ref name=Gar2011/> Additional causes include spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma.<ref name=Gar2011/><ref name=NIH2015/> Diagnosis of CES is typically suspected based on patient symptoms and further confirmed via medical imaging techniques such as MRI or CT scan.<ref name=Gar2011/><ref name=AO2014>

Cauda Equina Syndrome-OrthoInfo - AAOS(link). orthoinfo.aaos.org.

March 2014.

</ref>

Treatment and Prognosis

The primary treatment for CES involves surgical intervention, typically through a procedure known as laminectomy.<ref name=Gar2011/> However, despite surgical intervention, there may be persistent issues such as permanent bladder complications, sexual dysfunction, or numbness.<ref name=Gar2011/><ref name=AO2014/> Unfortunately, approximately 20% of individuals experiencing CES may have a poor outcome, even with treatment.<ref name=Gar2011/> The annual incidence of CES is roughly 1 in 70,000 people.<ref name=Gar2011>,

 Cauda equina syndrome: a review of the current clinical and medico-legal position., 
 European Spine Journal, 
 
 Vol. 20(Issue: 5),
 pp. 690–7,
 DOI: 10.1007/s00586-010-1668-3,
 PMID: 21193933,
 PMC: 3082683,</ref> The condition was first described in the medical literature in 1934.<ref>, 
 Timing of surgical intervention in cauda equina syndrome: a systematic critical review., 
 World Neurosurgery, 
 
 Vol. 81(Issue: 3–4),
 pp. 640–50,
 DOI: 10.1016/j.wneu.2013.11.007,
 PMID: 24240024,</ref>

Clinical Manifestations

Clinical symptoms of CES often include severe low back pain, along with the characteristic symptom of saddle anesthesia. This is a specific form of anesthesia or paraesthesia affecting the S3 to S5 dermatomes,<ref name=Larner2006>A.J.,

 A Dictionary of Neurological Signs, 
 2nd edition, 
 [New York]:Springer Science+Business Media, Inc., 
  
  
  
 ISBN 9780387262147,</ref>  including areas such as the perineum, external genitalia, and anus. To put it in simpler terms, patients often describe a feeling of numbness or "pins-and-needles" sensations in the areas of the groin and inner thighs that would contact a saddle when riding a horse.

Summary

Cauda Equina Syndrome represents a serious neurological condition requiring prompt diagnosis and treatment. Despite advancements in medical and surgical care, there may be significant and permanent sequelae in a subset of patients. A high index of suspicion and appropriate diagnostic evaluations are paramount in managing this condition to mitigate the potential for poor outcomes.

See Also

• Lumbar Disc Disease
• Spinal Stenosis
• Epidural Abscess

References

<references/>

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