Cauda equina syndrome (CES) is a serious lower back problem requiring emergency care.
What is Cauda Equina Syndrome?
The cauda equina, which look like a horse’s tail, are the nerve roots at the end of the spinal cord. The spinal cord ends at the lower back (lumbar) and the nerves in that region are responsible for sensory and motor functioning to the lower limbs and pelvic area, such as the legs and bladder. Cauda equina syndrome (CES) is when those nerves are compressed, typically due to a massive lumbar herniated disc that degenerates and ruptures. It can also be caused by the following: birth abnormalities, spinal arteriovenous malformations (AVMs), spinal hemorrhages, spinal tumors, spinal lesions, spinal stenosis, injuries (i.e., car accidents, falls, gunshots), spinal surgery complications, or spinal anesthesia. CES is extremely serious and can lead to paralysis and incontinence. If a patient is found to have this disorder, it typically requires emergency medical care. CES can look like other conditions, but there are “red flag symptoms”, such as 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. Patients with violent back injuries, cancer history, severe infections, or recent spinal surgery may be at risk. CES can be diagnosed via MRI or myelogram (x-ray of the spinal canal with contrast material injected).1
Treatment for CES should be immediate. Surgery, within 48 hours of symptoms, 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.2
Patients who have suffered from cauda equina syndrome have variable outcomes. The prognosis is based on the amount of nerve tissue damage suffered. The longer CES goes untreated, the longer the spinal cord is compressed; therefore, complete recovery is less likely. Unfortunately, CES is not typically preventable, as many of the conditions that cause it are unpredictable. The only exception to this would be CES caused by IV drug abuse. After the initial treatment of the disorder, the long-term management may include physical therapy, braces, pain medicine, catheters, and other interventions “until optimal nerve and muscle recovery occurs”.3 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.4