Cauda Equina Syndrome

Question 1

What Pathogenesis occurs in cauda equina?

Answer 1

Occasionally a very large central disc prolapse can compress all the nerve roots of the cauda equina

Question 2

What is cauda equina?

Answer 2

Surgical emergency

Question 3

What can prolonged compression cause?

Answer 3

Permanent nerve damage

• Colostomy
• Urinary Diversion

Question 4

Signs/symptoms of cauda equina?

Answer 4

• Bilateral leg pain
• Paraesthesiae/numbness
• Complain of saddle anesthesia
• Urinary retention/incontinence
• Faecal incontinence/constipation

Question 5

What is the rule for bilateral leg symptoms/signs with any suggestion of altered bladder or bowel function?

Answer 5

It is cauda equina syndrome until proven otherwise

Question 6

Investigation for Cauda equina syndrome?

Answer 6

PR mandatory

Urgent MRI - determine level of prolapse

Question 7

Treatment for cauda equina?

Answer 7

Urgent discectomy once diagnosis confirmed

Question 8

Prognosis of cauda equina syndrome?

Answer 8

Even with prompt intervention, significant number of patients have residual nerve injury sometimes with permanent bladder/bowel dysfunction