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Cauda Equina Syndrome: Causes, Symptoms and Treatment

Outline: Information regarding Cauda Equina Syndrome including causes, symptoms and treatment options.

Main Digest

The, 'cauda equine,' is a bundle of nerve roots at the lower end of a person's spinal cord. The cauda equine or, 'horse's tail,' is so-called because of the way it looks. A person's spinal cord is shorter than the spinal canal in which it runs, ending at around the same level as the first or second lumbar vertebra; it varies among people.

What is Cauda Equina Syndrome (CES)?

Cauda equina syndrome is a serious neurologic condition in which damage to the cauda equina causes acute loss of function of the lumbar plexus, (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord. CES is a lower motor neuron lesion. Early diagnosis can allow for preventive treatment. Signs that allow early diagnosis include changes in bowel and bladder function and loss of feeling in groin.

The cauda equina contains the nerve roots from L1 - S1-5. Nerve roots L4-S4 join in the sacral plexus which gives rise to the largest nerve in a person's body - the sciatic nerve. The sacral plexus is also involved in sensory and motor nerves to and from the genital and anal regions of a person's body. The nerve roots emerge in pairs from the relevant vertebral foramen. While leg pain; for example, is common and often goes away without surgery - cauda equina syndrome is a surgical emergency.

The nerve roots are an extension of a person's brain, sending and receiving messages to and from a person's pelvic organs and their lower limbs. Cauda equina syndrome occurs when the nerve roots in a person's lumbar spine are compressed, cutting of movement and sensation. Nerve roots that control the function of a person's bladder and bowel are particularly vulnerable to damage.

If people with cauda equina syndrome do not pursue immediate treatment to relieve the pressure it may result in:

Even if a person with cauda equina receives immediate treatment, they might not recover complete function. For people who experience this syndrome, family members and friends usually present with a blank look when the person affected mentions their condition. Even some doctors draw a blank look.

Cauda Equina syndrome is not a, 'back issue,' in the way people usually think of back trouble, although it may very well have occurred due to spinal issues such as a slipped disk. Medical and public awareness of cauda Equina syndrome needs to improve in order to circumvent instances that might be avoided through prompt treatment, as well as how to help those who experience the chronic form of the syndrome by recognizing their condition and helping them with measures that are appropriate to coping with the many issues the syndrome causes. Cauda Equina syndrome is:

Causes of Cauda Equina Syndrome

Cauda equina syndrome might be caused by a tumor, herniated disk, fracture, infection, or a narrowing of a person's spinal canal. Damage to the nerve roots in the cauda equina may also be caused by the following:

Cauda Equina syndrome due to compression or distortion may respond to quick removal of the cause, yet recovery depends on the duration of the injury and the degree of damage sustained. In inflammatory or demyelinating conditions; however, cauda Equina syndrome might be both chronic and progressive.

Symptoms of Cauda Equina Syndrome

Even though early treatment is required to prevent permanent issues, cauda Equina syndrome may be hard to diagnose. Symptoms vary in intensity and might evolve over a period of time. A specific pattern exists:

Cauda Equina syndrome is a devastating condition, one that may damage many aspects of the affected person's life. Often, the person can longer continue to work - either from severe pain, or because of a loss of muscle power, or because of continence issues. A combination of these issues may also affect a person's ability to work.

The syndrome causes symptoms that might be invisible and also about which the person might feel unable to speak because they relate to very personal bodily functions. Loss of bladder and bowel control can be highly distressing and have a negative impact on a person's social life, relationships and work. The person may also experience frequent urinary infections. A loss of sexual function can be devastating to the person and their partner and might lead to relationship difficulties and depression.

Severe neurogenic pain may be resistant to treatment and require strong painkillers with side-effects that might cause further issues for the person. If the pain is chronic it might become, 'centralized,' and affect other parts of the person's body while involving unusual pains such as electric shock type of pain, or pain from non-painful stimuli such as light touch. The person's pain may lead to their pain being viewed as neurotic or even worse if it is not recognized. The pain is also hard to treat and can be alarming for the person who may being to question their own sanity or fears the pain indicates some underlying and undiagnosed disease such as cancer.

With these issues in mind, it is not surprising that people with cauda equina syndrome may become depressed. They endure a number of losses such as loss of:

It is very possible that a person with cauda Equina syndrome and their loved ones may grieve over these losses and might need a considerable amount of support. It is important for a person to visit their doctor if they experience:

Treatments

Cauda Equina Syndrome:

People with cauda equina syndrome may need urgent surgery in order to remove the material that is pressing on the nerves. The surgery might prevent pressure on the nerves from reaching the point where the damages are irreversible. There are two forms of cauda Equina syndrome; Acute and Severe.

Acute Cauda Equina Syndrome:

The acute form requires extremely prompt surgical treatment if there is a compressive injury. The person may experience residual issues following the surgery and these may take months to resolve. Extensive rehabilitation using physiotherapy and methods such as bladder re-training might be required.

Chronic Cauda Equina Syndrome:

Chronic cauda Equina syndrome is much more difficult to treat. The person affected deals with pain, bladder and bowel control, weakness, sexual dysfunction and sensory loss. The person faces sore feet/ankles, poor circulation and depression.

General measures include reducing or stopping smoking, something that might help to improve local blood flow in the affected spinal region as well as in the person's lower limbs. Exercise may be beneficial within the limits of pain as loss of mobility can lead to additional issues such as osteoporosis.

Interacting with a Doctor

To achieve a diagnosis of cauda equina syndrome, a doctor evaluates a person's medical history, pursues a physical examination, and may order multiple diagnostic imaging studies. The diagnostic imaging studies can include x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) to help with assessment. A person's medical history can help to find out when the symptoms of cauda equina syndrome started.

During a physical examination related to cauda equina syndrome, a doctor assesses strength, reflexes, sensation, alignment and motion. The doctor may ask the person to sit, stand, walk on their heels and toes, bend backward, forward and to the sides, as well as to lift their legs while lying down. The doctor might check the tone and numbness of anal muscles. The person may also require blood tests.

Managing Bladder and Bowel Function

Some bladder and bowel function is automatic, although the parts under voluntary control might be lost if you have cauda Equina syndrome. What this means is you may not know when you need to urinate or move your bowels. A person with the syndrome may not have the ability to eliminate waste in the usual fashion.

Some general recommendations for managing bladder and bowel dysfunction include emptying your bladder with a catheter three to four times each day. Drink plenty of fluids and practice consistent personal hygiene in order to prevent urinary tract infections. Check for the presence of waste regularly and clear your bowels with gloved hands. You might want to use glycerin suppositories or enemas to help empty your bowels. Use protective pads and pants to prevent leaks.

CES from Lumbar Herniated Discs

CES from lumbar herniated discs is considered the only absolute indication for surgery. It is considered a neurosurgical emergency with the outcome related to how quickly it is diagnosed and treated. The results of recovery of bladder function are felt by many authors to be related to early diagnosis and surgical intervention. Most authors recommend a wide decompressive laminectomy when surgery is performed.

Cauda Equina Syndrome (CES) Statistics

Living With Cauda Equina Syndrome

The fact is - surgery might not repair permanent nerve damage. If this happens as a result of cauda equina syndrome, the person can learn how to improve their quality of life. Some suggestions include:

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