Cauda Equina Syndrome

Cauda equina syndrome (CES) is a serious but rare condition of the spine in which the bundle of nerve roots located at the lower (sacral) end of the spine become extremely compressed or inflamed. It is considered a medical emergency and requires immediate surgery to prevent permanent paralysis of the legs and/or incontinence. Cauda equina is named for the appearance of the affected nerve bundle extending from the lower portion of the spinal cord into the back of the legs.

CES is caused by extreme narrowing of the spinal canal due to nerve compression or inflammation. It can result from a number of underlying conditions, the most common of which is a severely ruptured lumbar disk. Other causes include:

• Spinal stenosis
• Spinal trauma
• Infection in the spinal canal
• Inflammatory spinal conditions such as ankylosing spondylitis
• Spinal tumor or lesion
• Spinal birth defect
  

Symptoms of CES can vary in intensity, with some patients reporting immediate onset and others reporting symptoms that appear more gradually. Patients with sudden onset commonly experience abrupt incontinence of the bladder and/or bowels and weakness in the legs and feet. Gradual onset symptoms can mimic other conditions of the spine and include back pain combined with numbness and weakness of the lower body, as well as increased incontinence. The symptoms below could indicate CES, and patients who experience any of the following should seek immediate medical treatment:

• Severe lower back pain
• Severe leg pain or weakness that interferes with motor activities such as walking, sitting and getting up from a chair
• Sudden onset of sexual dysfunction and/or bladder and bowel control
• “Saddle” anesthesia, or severe sensations in the areas of the body that would touch a saddle, such as the thighs, buttocks and lower back

The spine experts at Mischer Neuroscience Associates utilize a variety of state-of-the-art equipment to diagnose CES, with advanced technology that can help locate the precise area where compression originates and detect the underlying causing conditions. Diagnostic tests may include:

• Physical exam to test muscle strength, reflexes and nerve function
• X-ray
• MRI
• CT scan
• Myelography

Immediate surgical decompression is generally required to treat CES, with the goal of minimizing potentially permanent nerve damage that could lead to paralysis. Depending upon the underlying cause of CES, multiple treatments may be necessary. For example, physicians may use antibiotics to treat spinal infections, chemotherapy to treat malignant spinal tumors or corticosteroids for inflammatory spinal diseases.

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