Cauda Equina Syndrome: Definition| Treatments| Prognosis

What is Cauda Equina Syndrome?

Cauda equina syndrome (CES) is a serious lower back problem that requires swift emergency care. In the human body, the cauda equina, which look like a horse’s tail, are the nerve roots which are located at the end of the spinal cord. The spinal cord ends at the lower back, also known as the lumbar region. The nerves in that area are responsible for enacting sensory and motor functioning to the lower limbs and pelvic area, such as the legs and bladder.

Cauda Equina Syndrome Causes

Cauda equina syndrome (CES) is when those lumbar nerves are compressed. This is typically due to a massive lumbar herniated disc that degenerates and ruptures. It can also be caused by these other following reasons:

spinal arteriovenous malformations (AVMs),
spinal hemorrhages,
birth abnormalities,
spinal tumors,
spinal lesions,
injuries (i.e., car accidents, falls, gunshots),
spinal stenosis,
spinal surgery complications,
or spinal anesthesia

CES Symptoms

CES is extremely serious and can eventually lead to paralysis and incontinence. If a patient is found to have this disorder, it typically requires immediate emergency medical care.

Most of the symptoms and effects of CES can look like other conditions, but there are also some “red flag symptoms”. These include:

loss of extremity reflexes,
sudden sexual dysfunction,
bowel or bladder incontinence,
“saddle anesthesia”,
severe lower back pain,
motor weakness in the legs,
or sensory problems in the rectum or bladder.¹

In recent years, the list of red flag symptoms has become even more specific in an attempt to enable earlier referral and significantly benefit patient safety. Most of the previously known list is specified and expanded in the update. The updated list of warning signs includes:

bilateral sciatica,
difficulty with urination or an impaired sensation during flow,
loss of sensation of rectal fullness,
bilateral neurological deficit of the legs that is either severe or progressive,
paresthesia,
and a laxity of the anal sphincter.²

Patients with violent back injuries, cancer history, severe infections, or recent spinal surgery may be at an increased risk. CES can be diagnosed via MRI or myelogram, which is an x-ray done of the spinal canal with contrast material injected. These methods of testing could be ordered as a result of the patient reporting troubling symptoms which could indicate cauda equina syndrome or some other, similar condition.³

Treatments

Treatment for CES should be done almost immediately, as soon as possible after the condition has been diagnosed. Surgery is most effective when it is performed within 48 hours of the onset of symptoms. It is typically done to prevent permanent nerve damage, paralysis, and loss of bladder, bowel, and sexual functioning. Corticosteroids may also be required, and patients with infections will also need antibiotics. Patients who do not recover completely may require after-care from support groups, sex therapists, continence advisors, social workers, or physical and occupational therapists. This syndrome is one of those cases where its diagnoses should not be taken lightly and what is often in other cases considered to be extreme measures, such as undergoing surgery, are recommended to be the first options.⁴

Prognosis

Patients who have suffered from cauda equina syndrome and received treatment have variable outcomes depending on the speed at which they were able to address the condition. The prognosis is based on the amount of nerve tissue damage that has already been suffered. The longer CES is left to go untreated, the longer the spinal cord is compressed. Therefore, complete recovery is less likely as time goes on. Symptoms need to be identified quickly and immediate action needs to be taken for the best possible outcome.

Unfortunately, the initial onset of CES is not typically preventable, as many of the conditions that cause it are unpredictable. The only exception to this would be in the cases where the CES that has been caused by IV drug abuse. Otherwise, patients should do their best to lead a healthy lifestyle and learn how to identify and seek treatment for problems before they have been left to worsen.

Long Term Management

After the initial treatment of the disorder, the long-term management may include physical therapy, braces, pain medicine, catheters, and other interventions, which should be followed until optimal recovery of the nerves and muscles has occurred. Fortunately, there are a variety of those who fill the role of these treatment and recovery occupations who are professionally trained to make recommendations and help patients in their journey to recovery.⁵

Patients may also use pelvic floor exercises to help control bowel movements. However, bladder and bowel control may take two years to recover. Physical therapy tends to focus on stability and strength, as well as gait and balance. Electrical stimulation may also be useful. Patients need to be consistent with following the directions that they are given for recovery. Recovery will take time. However, it will take even longer or be less effective for those who are not compliant with safety and upkeep.⁶