Cauda equina syndrome

Question 1

What is cauda equine syndrome?

Answer 1

This is a syndrome caused by compression of the caudal equina, the nerve roots caudal to the level of spinal cord termination, leading to dysfunction of multiple lumbar and sacral nerve roots

Question 2

What is the most common cause of cauda equina syndrome?

Answer 2

Compression arising from a large central lumbar disc herniation at the L4-L5 and L5-S1 level

Question 3

What are some symptoms of cauda equina syndrome?

Answer 3

• Bilateral leg pain
• Loss of bladder or bowel control
• Perineal/saddle anaesthesia
• Widespread or progressive motor weakness

Question 4

What is a common clinical sign of cauda equina syndrome?

Answer 4

loss of anal sphincter tone on PR exam

Question 5

What investigations are required in cauda equina syndrome?

Answer 5

1. Urgent MRI of the lumbar spine to determine disc prolapse
2. Bladder scanning
3. Neurological testing

Question 6

What is the management option in cauda equina syndrome caused by disc prolapse?

Answer 6

Urgent discectomy

Question 7

What are some complications that can arise from cauda equina syndrome?

Answer 7

Prolonged compression can cause permanent nerve damage, causing permanent bladder and bowel dysfunction, requiring colostomy and urinary diversion