Cauda Equina

Question 1

What are the hallmark signs of CES?

Answer 1

-bilateral neurogenic sciatica
-reduced perianal sensation
-altered bladder function leading to painless urinary retention
-loss of anal tone
-loss of sexual function

Question 2

What are the different types of presentation for CES?

Answer 2

-can be acute with symptoms of lumbar disc herniation
-can be chronic after a long history of LBP
-can develop in a gradually progressive manner in days to weeks

Question 3

What is the epidemiology of CES?

Answer 3

-5-10/1000
-rare
-develops in only 2-3% of patients with disc herniation

Question 4

What is the etiology of CES?

Answer 4

-typically caused by a central disc prolapse at L4/5 or L5/S1
-can also be caused by a disc infection or tumor

Question 5

What are the red flags for CES?

Answer 5

-reduced awareness of bladder filling
-loss of urge to void
-reduced awareness that micturition is occurring
-inability to voluntarily interrupt stream of urine
-recent onset or progressively worsening weakness of urinary control
-loss of urethral sensation
-loss of perianal sensation
-inability to tell if bladder is full or empty
-inability to stop bowel movements from leaking
-inability to tell when you have had a bowel movement
-change in ability to achieve an erection or to ejaculate
-loss of genital sensation