Cauda Equina Syndrome Explained

Minor spinal issues such as lower back pain are fairly typical in the population as a whole and pain in this area is a common reason why many of us will visit the doctor. Due to the sedentary lifestyles that many of us are exposed to these days, issues with back pain are more prevalent than they once were.

More often than not, the underlying cause of lower back pain is not serious and the individual will feel better as time passes. However, pain in this area can be a symptom of something a lot more problematic. One particular condition, for which lower back pain is a primary symptom, is known as cauda equina syndrome (CES).

Here we take a closer look at this condition, what the symptoms are and how it can be treated.

What is Cauda Equina Syndrome?

The pain that accompanies cauda equina syndrome can be so severe in many instances that it requires emergency admission to hospital. It’s caused by a compression of the spinal roots in the lower part of the spine.

The cauda equina are a series of nerves located in the lumbosacral area of the spine. They are involved in sending messages to the pelvic organs, including the bladder, as well as the legs, and feet.

Symptoms of cauda equina syndrome can include severe pain, loss of sensation in the lower body as well as bladder and bowel issues. More details about the symptoms of cauda equina syndrome are provided below.

How Rare is Cauda Equina Eyndrome?

Cauda equina syndrome is a rare condition. In the USA, it affects between 1 in 33,000 and 1 in 100,000 people.  It accounts for up to 6% of lumbar disc operations that are carried out yearly.

What Causes Cauda Equina Syndrome?

The most common cause of cauda equina syndrome is a herniated or ruptured disc. In younger patients, this is usually caused by an accident or injury which puts excessive strain on the lumbar region.

In older patients, the degeneration of the spinal area due to age means that the syndrome can be caused by a more minor strain leading to a rupture.

There are other, less common, causes of cauda equina syndrome, including:

• Infection or inflammation involving the spine.
• Spinal lesion or tumor.
• Lumbar spinal stenosis (narrowing of the spinal column)
• Violent injury such as a gunshot wound or car accident
• Injury following a spinal operation
• Spinal anesthesia
• Abnormalities from birth
• Spinal arteriovenous malformations
• Spinal hemorrhages

Cauda Equina Syndrome Symptoms

Early symptoms of cauda equina syndrome may mimic other spinal conditions, which is why it can be difficult to diagnose in the initial stages. A lot can depend on how the compression of the spinal nerves progresses and the cause of that damage.

• The most common and obvious symptom of cauda equina syndrome is severe lower back pain.
• There is often weakness in lower limbs including the legs and feet and there is may well be bladder and bowel dysfunction.
• Cauda equina syndrome with neurogenic bladder is one complication which can cause issues such as loss of bladder sensation and incontinence as well as issues with urinary retention.
• A reduction in the reflex response in the lower limbs can be an early symptom of cauda equina syndrome as can sexual dysfunction.

Cauda Equina Syndrome Treatment

If cauda equina syndrome is left untreated it can lead to serious problems, including permanent paralysis. The standard intervention involves surgery to relieve the compression and the quicker this is carried out the better the outlook for the patient.

According to research, treatment within 48 hours of the onset of symptoms provides the best outcome (though a good result can be achieved after this date). This is one reason why it is important that an accurate diagnosis is obtained as soon as possible.

Following a physical examination, the main diagnostic tools used are:

• Magnetic resonance imaging (MRI)
• Myelogram (x-ray of the spine following the injection of a contrast material)
• CT scan

Once surgery has been carried out, the progress made during recovery will vary from person to person. It may take time before motor deficits in the lower limbs are restored and the bladder and bowel begin to function properly once again.

It might take several years to recover from neurogenic bladder or bowel issues. In some cases, full function is not recovered and individuals will need to manage the permanent symptoms of cauda equina syndrome.

If permanent damage has been caused, management will include working with occupational therapists and physiotherapists to improve daily living. There may be emotional challenges that come with chronic cauda equina syndrome, especially in instances where there are persistent bladder or bowel problems and/or the individual continues to experience severe pain.

Rare But Serious

Cauda equina syndrome is a serious but fairly rare condition that is caused by the compression of nerves in the lumbar region. Fast diagnosis and surgical intervention are vital in ensuring the best outcome, but some affected individuals may have to cope with long-term health issues as a result of their condition.