cauda equina

Question 1

what is cauda equina?

Answer 1

A rare condition where the lumbosacral nerve roots are compressed within the lumbosacral spinal canal

Question 2

what are the 5 hallmarks of CES?

Answer 2

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

Question 3

what are the 3 presentations of CES?

Answer 3

acute with symptoms of lumbar disc herniation
chronic with long history of LBP
gradually progressive manner in days to weeks

Question 4

epidemiology of CES:
- common or rare?
- develops in ____% of those with disc herniation

Answer 4

• rare: 5-10/1,000,000
• 2-3%

Question 5

how is CES typically caused?

Answer 5

central disc prolapse at L4/5 or L5/S1
OR disc infection or tumor

Question 6

what are some red flags of CES?

Answer 6

slide 8

Question 7

what setting can undiagnosed CES often show up in?

Answer 7

outpatient orthopedic

Question 8

what should you do if you notice a cluster of symptoms consistent with CES?

Answer 8

refer
–> you noticed hyporeflexive DTRs, (+) SLR, and bowel/bladder changes

Question 9

if acute where should you refer a CES patient to? what about chronic?

Answer 9

acute: ER
chronic: PCP w/ urgent neurologist referral

Question 10

your patient showing CES symptoms arrived in the ED. what would the physical findings be in the ED?
- dermatomes
- myotomes
- DTRs
- UMN signs
- Proprioception
- rectum???

Answer 10

• diminished
• diminished
• hyporeflexive
• No UMN signs
• problematic
• rectal exam for sphincter control

Question 11

what imaging would be performed in the ED for someone with CES?

Answer 11

ultrasound of bladder
MRI -> want to know subtle details for surgical intervention
** CT only if MRI is unavailable

Question 12

true or false. CES is NOT a surgical emergency

Answer 12

false - it is

Question 13

typically a ________ surgery is required, but they may need _____ as well if still unstable after decompression

Answer 13

decompression
stabilization

Question 14

surgery in the first _____ hours of acute onset improves outcomes. why?

Answer 14

48 hours
stops compression on the cord

Question 15

will a patient with CES require help with bowel/bladder management? if so, what would they require?

Answer 15

yes
foley catheter initially
depending on severity –> self catheterization
LMN focused bowel program
nursing/MD/PT/OT all educate

Question 16

how is balance and gait affected in those with CES?

Answer 16

likely have partial innervation of legs
may start w/c but progress to balance and gait
may need bracing

Question 17

a patient with CES is a __(UMN/LMN)___ syndrome.
what would the exam findings be?

Answer 17

LMN
hypotonia
areflexia/absent DTRs
flaccid bowel and bladder
no UMN signs
psychogenic sexual function
no spasticity but may have fasciculations

Question 18

you are a PT working in acute care. You got orders to see a patient post-surgery for CES. what’s your next steps?

Answer 18

chart review to see if pt has precautions
subjective history
first 72 hours - ASIA
check skin, environment, vitals
DTRs
UMN signs
basic mobility

Question 19

what are some interventions for CES in acute care?

Answer 19

education on injury, skin protection, bowel/bladder
positioning
ROM
basic mobility tasks
out of bed to w/c
assess for bracing or w/c needs
d/c planning (OP vs. IP)

Question 20

you are a PT working in acute rehab. a CES patient just arrived and you are to do an exam/eval on them. what are you checking?

Answer 20

sensory/motor
pain
skin
education carryover
basic mobility
need for bracing/custom seating
UMN signs
reflexes
goals
home set up

Question 21

what interventions are you focusing on for CES in acute rehab?

Answer 21

balance, bed mobility, scooting, transfers, w/c propulsion, pre-gait, gait
contact CPO or ATP
education on injury patient/family caregiver management at home
return to community tasks

Question 22

you are a PT working in OP neuro clinic. you have an eval for a pt with CES. what is one thing you are going to focus on that wasn’t checked in acute rehab?

Answer 22

secondary injuries (RTC, elbow, scoliosis)

Question 23

what are interventions for CES in an OP clinic?

Answer 23

higher level balance/gait training
higher level w/c training
higher level ADLs/home management
independence with bowel/bladder management
return to sport
return to work/school/community activities

Question 24

what are you looking for when chart reviewing before seeing a patient with CES?

Answer 24

notes from ED
imaging
post-op report –> precautions, stable?