Cauda equina syndrome is a very serious condition.
What is Cauda Equina Syndrome?
Cauda equina syndrome (CES), is considered to be a very “serious neurologic condition” in which the cauda equina is damaged, leading to a “loss of function of the…(nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord”. Symptoms include back pain that is severe, saddle anesthesia (“pins-and needles” feeling in the inner thighs and groin), bowel dysfunction, bladder dysfunction, sciatica, weakness in the legs, sexual dysfunction, and gait disturbance. Any patient presenting with the “red flags” of saddle anesthesia and severe back pain, sexual dysfunction, and incontinence would require immediate medical attention. The nerves beyond the conus medullaris are in a mass like a “horse-tail”, hence the name “cauda equina”. Any trauma to the region or compression can lead to CES. Tumors and lesions may also cause the condition, but the most common cause is “central disc prolapse”. The trauma causes include knife wounds, ballistic trauma, spinal anesthesia, burst fractures, lumbar punctures, or “severe disc herniations”. Cauda equina syndrome can be triggered by lumbar spinal stenosis as well. Spinal stenosis is a condition in which there is a narrowing of the spinal canal, usually due to degeneration (osteoarthritis) or a developmental defect. A very severe case of spondylolisthesis could cause CES. Sometimes inflammatory conditions may lead to this condition as well, such ankylosing spondylitis, and Paget disease. Disc herniation is a major risk factor, and early diagnosis can lead to preventive treatment. The longer a patient lives with the dysfunction, the greater the chances are of nerve damage.1
What is Conus Medullaris Syndrome?
CES is not exactly the same thing as conus medullaris syndrome. Conus medullaris syndrome is “a type of incomplete spinal cord injury” with symptoms that are similar to CES. Symptoms include bowel or bladder dysfunction, severe back pain, sexual dysfunction, tingling, numbness, and weakness in the lower limbs, numbness, buzzing, or tingling in the back, and “sensations in your lower limbs that aren’t caused by a clinical issue” (itchiness, for example). The conus medullaris ends at the cauda equina, and problems with the former can affect the latter. Conus medullaris syndrome is from spinal trauma, such as from a gunshot, car accident, or other blow to the lower back. Sometimes it may be caused by infections, spinal stenosis, or tumors. Even though symptoms are similar to cauda equina syndrome, treatments may differ. Conus medullaris syndrome causes “sudden symptoms on both sides of the body”, whereas CES “develops over time, producing uneven symptoms concentrated on one side of the body”. Conus medullaris pain might be only mild or moderate, compared to CES, and it is more likely to cause impotence and “pain concentrated in the lower back”. Treatments include spinal decompression surgery, radiation (if cancer is the cause), antibiotics (for an infectious cause), and physical therapy.2 There are online sources that compare and contrast CES and conus medullaris syndrome presentation, reflexes, radicular pain, lower back pain, symptoms, motor strength, and sexual and sphincter dysfunctions.3
Treatment and Rehabilitation of CES
Surgical decompression is typically recommended for cauda equina syndrome, especially when caused by disc herniation. However, when CES has a sudden onset, it is a medical emergency, and laminectomy might be performed. In those situations, early treatment could help the patient avoid “long-term neurological damage”. Surgery aims to remove the source of the pressure. Some patients might benefit from steroids (if the cause is inflammatory) or antibiotics (if the source is a bacterial infection). If the patient is pregnant, surgery can still proceed. Patients should also examine lifestyle issues, such as obesity, and they likely will need occupational therapy and physiotherapy for rehabilitation. Rehabilitation is focused on controlling the bowel and bladder and improving the lower extremity muscles. Patients may need catheterization to assist with bladder control, and they can learn pelvic floor exercises for the bowel control. It might take 2 years to resolve these incontinence conditions. Physical therapy is aimed at the goals of strength training, stability, balance, and gait. Electrical stimulation might be used to assist with improving muscle tone. Without early intervention, nerve regrowth may become impossible, leading to permanent damage. It may take “several years” of recovery time if interventions come too late.4 For some patients, a tumor caused the CES, and these patients might need chemotherapy or radiation after surgery. Besides the OT and PT help, a social worker, continence advisor, or sex therapist might become involved in the patient’s case.5 Exercise could benefit patients with cauda equina syndrome, such as aerobics and strength training. Walking, biking, swimming, leg extension, calf raises, and hamstring curls are some of the recommended exercises. Safety is important, and patients should work with their physical or occupational therapist, at first. After several weeks, independent physical activities might be allowed.6 CES resulting in nerve damage is a very rare condition.7
Learn more about cauda equina syndrome.