What is cauda equina syndrome?
Cauda equina syndrome is the medical term for compression, damage or injury to the portion of nerves at the end of your spinal cord called the cauda equina. Cauda equina is Latin for “horses tail” an accurate description of what the nerve bundle looks like. The cauda equina contains the nerve roots from level L1-5 from the low back and S1-5 from the sacrum. Cauda equina syndrome is classed as a medical emergency and requires immediate investigation and treatment to prevent permanent damage.
Why and when does cauda equina syndrome happen?
Cauda equina syndrome is rare and most commonly seen in adults. There are two groups of causes of cauda equina syndrome, congenital and acquired. Congenital causes are causes from birth including spina bifida or tumours of the cauda equina. The acquired group of causes play more of a role in developing cauda equina syndrome in adulthood. These include spinal injury or trauma, the development of a tumour of the cauda equina, post-operative complication of spinal surgery and certain infections and vascular problems to the area. The most common cause is a disc herniation in the lumbar spine either at the level of L4/L5 or L5/S1. When a disc herniation happens it will most commonly happen to the side causing compression of the spinal nerve as it exits the spinal cord however in the case of cauda equina syndrome the disc herniation happens in the centre causing narrowing of the spinal canal and compression of the cauda equina.
What does cauda equina syndrome feel like?
Cauda equina syndrome can vary greatly from the more common sudden onset of a couple of hours to the milder more gradual progression of symptoms over a couple of days to weeks. The group of nerves that form the cauda equina supply the low back, buttocks, lower legs and bowel and bladder, hence why the symptoms appear in these areas. Most but not all patients will suffer from low back pain this is normally accompanied by severe “sciatica” like leg pain often in both legs. The saddle area around your buttocks will feel numb; patients often report not being able to feel anything when they wipe their bottom. Bowel and/or bladder changes are seen this includes increased frequency of going to the toilet, constipation or even complete incontinence. Remember that these symptoms and changes normally occur suddenly and out of the blue, however do occasionally happen gradually. If you do feel you have similar symptoms to the ones just listed it is recommended you seek immediate medical attention.
How is cauda equina syndrome diagnosed?
It is normally advisable to report to A&E as it is classed as an emergency. Your Doctor will most likely be able to diagnose you from listening to the history of your symptoms and by examining you. You will then be referred for further investigation, this normally comes in the form of an MRI scan but occasional ultrasound or CT scans are used. The MRI scan is used to locate the exact site of the compression and identify the underlying cause.
What treatment is available for cauda equina syndrome?
Patients suffering from cauda equina syndrome are referred very quickly for decompression surgery; the longer surgery is delayed the higher the patient’s chance of developing permanent neurological damage, including paralysis, loss of or impairment of bowel and bladder function and in some cases sexual function. Patients will be provided with physiotherapy care post op to rehabilitate and strengthen their lower back and an occupational therapist will be able to help patients deal with and adapt to any permanent impairments.