Cauda Equina Syndrome Flashcards
What is the cauda equina?
It is defined as the tail end of the spinal cord situated inferior to the L2 vertebral level
What is cauda equina syndrome (CES)?
It is defined as a condition in which there is compression of the lumbosacral nerve roots forming the cauda equina
What are the two classifications of cauda equina syndrome?
Incomplete Cauda Equina Syndrome
Complete Cauda Equina Syndrome
What is incomplete cauda equina syndrome?
It is defined as cauda equina syndrome which resutls in urinary difficulties, altered urinary sensation, urinary hesitancy and urinary urgency
What is complete cauda equina syndrome?
It is defined as cauda equina syndrome which results in definitive urinary retention, associated with overflow incontinence
What six risk factors are associated with cauda equina syndrome?
Lumbar Disc Herniation
Spinal Malignancy
Spinal Infection
Spinal Vertebral Fractures
Spinal Anaesthesia
Post-Operative Haematoma
What is the most common risk factor associated with cauda equina syndrome?
Lumbar Disc Herniation
What two lumbar disc herniations are assoicated with cauda equina syndrome?
L4/L5 Disc Herniation
L5/S1 Disc Hernation
What three malignancies commonly metastasise to the spine?
Breast
Prostate
Lung
What are the eleven clinical features of cauda equina syndrome?
Severe Lower Back Pain
Bilateral Sciatica
Saddle Paraesthesia
Bladder Dysfunction
Bowel Dysfunction
Sexual Dysfunction
Reduced Perineal Sensation
Reduced Anal Sphincter Tone
Muscle Weakness
Hypotonia
Areflexia
What is saddle paraesthesia?
It is defined as a sensation of tingling and numbness in the perianal region
Which clinical feature is a late sign of cauda equina syndrome, which indicates potentially an irreversible damage?
Urinary Incontinence
What two investigations are used to diagnose cauda equina syndrome?
Lumbar-Sacral Spine MRI Scans
CT Myelograms
What is the gold standard investigation used to diagnose cauda equina syndrome?
Lumbar-Sacral Spine MRI Scans
When are spine MRI scans used to diagnose cauda equina syndrome?
They should be conducted urgently within 6 hours
What is the feature of cauda equina syndrome on spinal MRI scans?
Cauda Equina Compression
When are CT myelograms used to diagnose cauda equina syndrome?
They are the second line investigation used to diagnose cauda equina syndrome – in which MRI scans are contraindicated
What is the feature of cauda equina syndrome on CT myelograms?
An hourglass shape to the contrast-filled thecal sac
Do we conduct dianostic imaging or immediate surgical management in cauda equina syndrome?
The imaging scans are always required, in order to establish the causative aetiology, level of pathology and to prepare for surgical management
What is the most appropriate management step in suspected cauda equina syndrome?
We urgently refer to neurosurgery
What are the three immediate management options of cauda equina syndrome?
ABCDE Approach
IV Analgesia
Catheter Insertion
What is the gold standard management option of cauda equina syndrome?
Urgent Surgical Decompression
What is surgical decompression?
It involves laminectomy (removal of vertebral lamina), discectomy (removal of the intervertebral disc, or both, as well as the removal of any other compressive lesions
What are the five complications associated with cauda equina syndrome?
Lower Limb Numbness
Paraplegia
Chronic Urinary Retention
Chronic Urinary Incontinence
Chronic Sexual Dysfunction
