Cauda Equina Syndrome

Cauda Equina Syndrome

synonyms:Cauda Equina Syndrome, CES

Cauda Equina Syndrome ICD-9

Cauda Equina Syndrome Etiology / Epidemiology / Natural History

• Etiology: severe compression of the lumbar and sacral nerve roots.
• Left untreated patients may develop permanent bowel, bladder and sexual dysfunction with severe personal and social implications.

Cauda Equina Syndrome Anatomy

• Central disk prolapse at L4-5 or L5-S1 with or without a congenitally narrow spinal canal or osseous hypertrophy can lead to Cauda Equina syndrome.

Cauda Equina Syndrome Clinical Evaluation

• Severe bilateral leg pain, weakness, saddle anesthesia (perianal numbness), bowel/bladder symptoms (urninary retention early, urine/bowel incontinence late), impotence (sexual dysfunction).
• May present as an acute loss of perianal sensation and sphincter disturbances, chronic back pain with or without sciatica, or slowly progressive numbness with urinary tract symptoms (Lavy, BMJ 2009;338:881).

Cauda Equina Syndrome Xray / Diagnositc Tests

• MRI indicated to evaluate for L4-5 of L5-S1 disc herniation. CT may be used if MRI is not urgently available.
• 87% recover normal bladder function if decompressed within 24 hours. 43% recover normal bladder function if decompressed after 24 hours.

Cauda Equina Syndrome Classification / Treatment

• Treatment = emergent decompression, discectomy. Outcomes are worse with decompression done after >24 hours. (Shapiro S, Spine 2000;25;348).

Cauda Equina Syndrome Associated Injuries / Differential Diagnosis

Cauda Equina Syndrome Complications

• Urologic dysfunction
• Chronic pain
• Sexual dysfuction
• Permanent weakness

Cauda Equina Syndrome Follow-up Care

Cauda Equina Syndrome Review References