Cauda equina

Question 1

What is cauda equina syndrome?

Answer 1

Surgical emergency caused by a compression of the Cauda Equina

Question 2

What actually is the Cauda equina?

Answer 2

Bundle of nerves inferior to the spinal cord

Question 3

Where does the spinal cord taper to an end?

Answer 3

L1

Question 4

What nerve roots pass down the spinal canal as the cauda equina?

Answer 4

L1-S5

Question 5

What part of the body is affected by the cauda equina syndrome?

Answer 5

Motor and sensory to the Lower limb, motor to the anal spinchters and parasympathetic to the bladder

Question 6

What can cause cauda equina syndrome?

Answer 6

Disc herniation, trauma, neoplasms, infection, chronic spinal inflammation, iatrogenic

Question 7

What level is disc herniation most common?

Answer 7

L5/S1 and L4/L5

Question 8

What are the most common cancers to metastasise to the spine?

Answer 8

thyroid, breast, lung, renal and prostate

Question 9

What infection can cause cauda equina syndrome?

Answer 9

Discutais or potts disease

Question 10

What can cause chronic spinal inflammation?

Answer 10

ankylosing spondylitis

Question 11

What are some iatrogenic causes of cauda equina syndrome?

Answer 11

haematoma secondary to spinal anaesthesia

Question 12

What are the symptoms of Cauda equina syndrome?

Answer 12

Reduced lower limb sensation, bladder or bowel dysfunction, lower limb motor weakness, severe back pain, impotence

Question 13

On examination what will the features of Cauda Equina syndrome be?

Answer 13

Perianal or lower limb anaesthesia, loss of anal tone, urinary retention, lower limb weakness and hypoflexia

Question 14

What are the 3 groups of cauda equina?

Answer 14

Cauda Equina syndrome with retention, Incomplete cauda equina syndrome, suspected cauda equina syndrome

Question 15

What is Cauda Equina syndrome with retention?

Answer 15

back pain, sciatica, lower limb motor weakness, sensory disturbance in the saddle region, loss of anal tone and loss of urinary control

Question 16

What is incomplete cauda equina syndrome?

Answer 16

Same as cauda equina with retention but will only have altered urinary sensation so loss of desire to void, diminished sensation and poor stream, need to strain

Question 17

What is suspected cauda equina syndrome?

Answer 17

cases of severe back and leg pain with variable neurological symptoms and signs, and a suggestion of sphincter disturbance

Question 18

Is cauda equina syndrome progressive?

Answer 18

Yes as will not usually immediately cause complete compression on the cauda equina, which is more likely to have recovery

Question 19

What are some differential diagnosis for Cauda Equina syndrome?

Answer 19

Radiculopathy or cord compression

Question 20

What investigations would be done for Cauda Equina syndrome?

Answer 20

Whole spine MRI

Question 21

What is the management for Cauda equina Syndrome?

Answer 21

early neurosurgical review for urgent decompression, high dose steroids to reduce swelling, trauma immobilisation

Question 22

What is the prognosis like for Cauda Equina syndrome?

Answer 22

If in theatre within 24 hours less likely to have bladder problems on follow up