Cauda Equina Syndrome

Question 1

What is the cauda equina?

Answer 1

It is defined as the tail end of the spinal cord situated inferior to the L2 vertebral level

Question 2

What is cauda equina syndrome (CES)?

Answer 2

It is defined as a condition in which there is compression of the lumbosacral nerve roots forming the cauda equina

Question 3

What are the two classifications of cauda equina syndrome?

Answer 3

Incomplete Cauda Equina Syndrome

Complete Cauda Equina Syndrome

Question 4

What is incomplete cauda equina syndrome?

Answer 4

It is defined as cauda equina syndrome which resutls in urinary difficulties, altered urinary sensation, urinary hesitancy and urinary urgency

Question 5

What is complete cauda equina syndrome?

Answer 5

It is defined as cauda equina syndrome which results in definitive urinary retention, associated with overflow incontinence

Question 6

What six risk factors are associated with cauda equina syndrome?

Answer 6

Lumbar Disc Herniation

Spinal Malignancy

Spinal Infection

Spinal Vertebral Fractures

Spinal Anaesthesia

Post-Operative Haematoma

Question 7

What is the most common risk factor associated with cauda equina syndrome?

Answer 7

Lumbar Disc Herniation

Question 8

What two lumbar disc herniations are assoicated with cauda equina syndrome?

Answer 8

L4/L5 Disc Herniation

L5/S1 Disc Hernation

Question 9

What three malignancies commonly metastasise to the spine?

Answer 9

Breast

Prostate

Lung

Question 10

What are the eleven clinical features of cauda equina syndrome?

Answer 10

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

Question 11

What is saddle paraesthesia?

Answer 11

It is defined as a sensation of tingling and numbness in the perianal region

Question 12

Which clinical feature is a late sign of cauda equina syndrome, which indicates potentially an irreversible damage?

Answer 12

Urinary Incontinence

Question 13

What two investigations are used to diagnose cauda equina syndrome?

Answer 13

Lumbar-Sacral Spine MRI Scans

CT Myelograms

Question 14

What is the gold standard investigation used to diagnose cauda equina syndrome?

Answer 14

Lumbar-Sacral Spine MRI Scans

Question 15

When are spine MRI scans used to diagnose cauda equina syndrome?

Answer 15

They should be conducted urgently within 6 hours

Question 16

What is the feature of cauda equina syndrome on spinal MRI scans?

Answer 16

Cauda Equina Compression

Question 17

When are CT myelograms used to diagnose cauda equina syndrome?

Answer 17

They are the second line investigation used to diagnose cauda equina syndrome – in which MRI scans are contraindicated

Question 18

What is the feature of cauda equina syndrome on CT myelograms?

Answer 18

An hourglass shape to the contrast-filled thecal sac

Question 19

Do we conduct dianostic imaging or immediate surgical management in cauda equina syndrome?

Answer 19

The imaging scans are always required, in order to establish the causative aetiology, level of pathology and to prepare for surgical management

Question 20

What is the most appropriate management step in suspected cauda equina syndrome?

Answer 20

We urgently refer to neurosurgery

Question 21

What are the three immediate management options of cauda equina syndrome?

Answer 21

ABCDE Approach

IV Analgesia

Catheter Insertion

Question 22

What is the gold standard management option of cauda equina syndrome?

Answer 22

Urgent Surgical Decompression

Question 23

What is surgical decompression?

Answer 23

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

Question 24

What are the five complications associated with cauda equina syndrome?

Answer 24

Lower Limb Numbness

Paraplegia

Chronic Urinary Retention

Chronic Urinary Incontinence

Chronic Sexual Dysfunction