What is Cauda Equina Syndrome?
Cauda Equina Syndrome occurs when there is severe compression of the lumbar and sacral nerve roots in the lower back. This is usually caused by a severe midline herniation of the intervertebral disc. It is considered a diagnostic and surgical emergency as delay in care can result in permanent lower spinal nerve damage. It may present acutely or chronically and requires both perianal and saddle paresthesia (numbness) as well as bowel, urinary or sexual dysfunction. It is estimated to occur in approximately 1% of herniated lumbar discs.
Symptoms
Signs and symptoms overlap in many cases with other causes of lower back pain. These symptoms may also be unilateral or bilateral and include:
- Low back pain
- Sciatica-pain from the sciatic nerve from the lower back to down the leg
- Paresthesia of the lower limbs and perianal area
- Saddle paresthesia-numbness and tingling of the inner thighs and lower groin
- Weakness of the lower limbs
- Reduced or absent lower limb reflexes
- Decreased urinary urgency with no incontinence
- Urinary or bowel retention or incontinence
Causes
There are many possible causes of Cauda Equina Syndrome. It is most often caused by the posterior herniation of the lumbar discs but may be cause by the following:
- Degenerative: lumbar disc herniation and spinal canal stenosis
- Inflammatory: ankylosing spondylitis
- Traumatic-spinal fracture or dislocation; epidural hematoma
- Vascular: Aortic dissection or arteriovenous malformation
- Infective-infection of the brain or meninges; tuberculosis (Pott’s disease)
- Tumors: both primary or metastatic
Diagnosis
Diagnosis is suggested by a combination of a patient’s history and symptoms. MRI (Magnetic Resonance Imaging) Scans are the test of choice and should show impingement of the lumbar nerve roots with narrowing of the lower spinal canal.
Treatment
Cauda Equina Syndrome is considered to be a surgical emergency. Early surgical decompression of the narrowed area is most likely to produce the best results. Even with decompression, patients may have persistent bowel or urinary incontinence, sexual dysfunction, or lower limb weakness or paresthesias.
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The pain and risk of permanent disability make Cauda Equina Syndrome as surgical emergency. The Neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of Cauda Equina Syndrome. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).