Cauda Equina Syndrome

Question 1

ESSENCE

Answer 1

Compression of nerve roots forming the cauda equina

Question 2

AETIOLOGY

Common causes

Answer 2

• Any pathology that compresses nerve roots
  
  • Lumbar disc herniation (most commonly L4/5, L5/S1 levels)
  • Spinal vertebral fracture
  • Malignancy
  • Spinal infection

Question 3

CLINICAL FEATURES

Presentation

Answer 3

• Severe back pain
• Bilateral sciatica
• Perianal (“saddle”) anaesthesia
• Bowel and bldder dysfunction - commonly urinary retention
• Sexual dysfunction

Question 4

CLINICAL FEATURES

Examination findings

Answer 4

• LMN signs
  
  • Hypotonia
  • Bilateral or unilateral weakness
  • Arflexia
  • Abnormal sensory changes

Question 5

CLINICAL FEATURES

Rectal findings

Answer 5

• Saddle anaesthesia
• Reduced perineal sensation
• Reduced anal sphincter tone/loss anal squeeze

Question 6

INVESTIGATIONS

First choice

Answer 6

• MRI spine
• CT myelogram if MRI contraindicated

Question 7

MANAGEMENT

General principles

Answer 7

• Stabilise patient - ABCDE
• Analgesia
• Catheter if urinary retention
• Discussed with neurosurgery - surgical emergency

Question 8

MANAGEMENT

Surgical options

Answer 8

• Decompression with maybe laminectomy (removal vertebral lamina), dicestomy (removal intervertebral disc), or both as well as removal of any compressive lesions