Cauda Equina

Question 1

What is the cauda equina?

Answer 1

The nerve roots caudal to spinal root termination

Question 2

What can cause cauda equina syndrome?

Answer 2

Herniation of lumbar at L4/5 or L5/S1, tumours, trauma, infection, late-stage ankylosing spondylitis, postoperative haematoma, sarcoidosis

Question 3

How quick is onset?

Answer 3

Sudden - hours

Question 4

How does CES present?

Answer 4

Saddle paraesthesia, bladder/bowel dysfunction, sexual dysfunction, motor problems, lower back pain, bilateral LMN weakness, absent ankle reflex

Question 5

What is CES?

Answer 5

A medical emergency

Question 6

What would you find on a rectal exam?

Answer 6

Loss of anal tone/sensation

Question 7

What imaging would you do?

Answer 7

MRI of spine

Question 8

What management is essential?

Answer 8

Surgical decompression

Question 9

What should you do to the spine?

Answer 9

Immobilise it

Question 10

How else would you manage it?

Answer 10

Anti-inflammatory agents, antibiotics if infection, chemo if indicated