[17] Cauda Equina Syndrome Flashcards
What is cauda equina syndrome?
A condition that occurs when the bundle of nerves below the end of the spinal cord is damaged
What is the cauda equina?
A bundle of nerves below the conus medullaris
Where does the cauda equina branch from?
The lower end of the spinal cord
What nerve roots does the cauda equina contain?
- L1-L5
- S1-S5
What do the nerve roots from L4 to S3 join to form?
The sciatic nerve
Where do the nerve roots combine to form the sciatic nerve?
The sacral plexus
Where does the sciatic nerve travel?
Towards the feet (caudally)
How does cauda equina syndrome arise?
Compression, trauma or other damage to the spinal canal that contains the cauda equina
What are the potential cause of cauda equina syndrome?
- Herniation of a lumbar disc
- Tumours
- Trauma
- Infection
- Epidural abscess
- Congenital defects
- Spondylolisthesis
- Late-stage ankylosing spondylitis
- Post-operative haematoma
Herniated discs at what levels most commonly cause cauda equina syndrome?
- L4/5
- L5/S1
What tumours can cause cauda equina syndrome?
- Metastases
- Lymphoma
- Spinal tumours
What congenital defects can cause cauda equina syndrome?
- Congenital spinal stenosis
- Kyphoscoliosis
- Spina bifida
What are the risk factors for disc herniation?
- Male
- Heavy lifting
- Middle age
What is the period of onset for most cases of cauda equina syndrome?
Suddent onset with rapid progression within hours to days
How can cauda equina syndrome rarely present?
With a slowly evolving painless onset
Do all patients have a complete cauda equina syndrome?
No, 30-50% have a partial syndrome
What are the symptoms of cauda equina syndrome?
- Low back pain
- Pain in legs
- Uni-/bi-lateral lower limb sensory deficit
- Uni-/bi-lateral lower limb motor deficit
- Bowel and/or bladder dysfunction
- Saddle and perianal anaesthesia
- Sexual dysfunction
What urinary dysfunctions may occur in cauda equina syndrome?
- Retention
- Difficulty starting or stopping stream
- Overflow incontinence
- Decreased bladder or urethral sensation
What bowle dysfunctions may occur in cauda equina syndrome?
- Faecal incontinence
- Constipation
- Loss of anal tone and sensation on rectal examination
How is cauda equina syndrome typically diagnosed?
Clinical diagnosis
What can assist the clinical diagnosis of cauda equina syndrome?
Radiological imaging
What is the preferred imaging modality for confirming a diagnosis of cauda equina syndrome?
MRI
What can MRI also show in cauda equina syndrome?
The level of compression and underlying cause
When can suspected cauda equina syndrome be ruled out?
Only if refuted by MRI
What other imaging modalities can be used in the investigation of cauda equina syndrome?
Myelography and CT scan
What are further investigations of cauda equina syndrome concerned with?
Localising the site of compression and the underlying cause
What are the potential differentials for cauda equina syndrome?
- Conus medullaris syndrome
- Mechanical back pain
- Prolapsed lumbar disc
- Fracture of lumbar vertebrae
- Spinal tumour
- Spinal cord compression
- Peripheral neuropathy
What is conus medullaris syndrome?
Similar to cauda equina syndrome but with less prominent nerve root pain and mainly urinary retention and constipation problems
What should be done once cauda equina syndrome is suspected?
Immediate referral for neurosurgical consultation
What is indicated in most patients with cauda equina syndrome?
Urgent spinal decompression
Why is urgent spinal decompression often indicated in cauda equina syndrome?
To prevent permanent neurological damage
What can be given in cauda equina syndrome due to malignant disease to relieve cord compression if surgery is not an option?
Radiotherapy
What do other treatment options in cauda equina syndrome depend on?
The underlying cause
What treatment options may be useful in patients with cauda equina syndrome and an underlying inflammatory cause?
Anti-inflammatory agents including steroids
What is an example of an inflammatory cause of cauda equina syndrome?
Ankylosing spondylitis
What should infectious causes of cauda equina syndrome be treated with?
Appropriate antibiotics
What should patients with spinal neoplasms causing cauda equina syndrome be evaluated for?
Chemotherapy and radiotherapy
What post-operative care is needed in cauda equina syndrome?
- Addressing lifestyle issues
- Physiotherapy
- Occupational therapy
What are the potential complications of cauda equina syndrome?
- Paralysis
- Sensory abnormalities
- Bladder, bowel and sexual dysfunction
