Cauda Equina Syndrome is classed as a ‘Spinal Emergency’.
The spinal cord extends from the brain down through a canal inside the vertebral column. At each level of the spine, there are nerves branching off from your spinal cord. These are called nerve roots. They are responsible for sending signals to and from the muscles and other structures throughout the body.
The area which we need to concentrate on is the area of the spine which is approximately just above the waist. This area of the spine is where the spinal cord finishes. Below this is the group of nerves which are called the Cauda Equina.
The nerves of the Cauda Equina are responsible for the supply of nerves to the bladder, bowels, and lower limbs and also supply sensation to the skin around the bottom and back passage.
Cauda equina syndrome (CES) occurs when there is dysfunction of multiple lumbar and sacral nerve roots of the cauda equina.
Cauda equina syndrome usually results from a massive herniated disc in the lumbar region. A single excessive strain or injury may cause a herniated disc, however, many disc herniations do not necessarily have an identified cause. The size of the disc herniation that results in cauda equina is often much larger than normal; however, if the spinal canal is smaller due to conditions such as arthritis, a smaller disc herniation can produce CES.
Patients with CES may experience some or all of these “red flag” symptoms.
- Urinary retention: the most common symptom. The patient’s bladder fills with urine, but the patient does not experience the normal sensation or urge to urinate.
- Urinary and/or faecal incontinence. An overfull bladder can result in incontinence of urine. Incontinence of stool can occur due to dysfunction of the anal sphincter.
- “Saddle anaesthesia” sensory disturbance, which can involve the anus, genitals and buttock region.
- Weakness or paralysis of usually more than one nerve root. The weakness can affect the lower extremities.
- Pain in the back and/or legs (also known as sciatica).
- Sexual dysfunction.
If a patient is experiencing any of the “red flag” symptoms above, immediate medical attention is required to evaluate whether these symptoms represent CES.
Cauda equina syndrome typically requires prompt surgical decompression in order to reduce or eliminate pressure on the impacted nerves. Most surgeons recommend decompression as soon as possible, within about 8 hours of the onset of symptoms if symptoms develop suddenly.
Recovering from a spinal decompression procedure such as lumbar laminectomy or discectomy can take about four to six weeks. This timeline depends on individual health factors such as age, general health and the cause of the compression. During that time, activities are gradually increased over time while the incision heals and stitches are removed. People who have sedentary jobs that don’t require much lifting or bending can generally get back to work in about four weeks, but people with physically demanding jobs might need to recover for up to four months before returning to work.