Cauda equina syndrome

Question 1

Definition

Answer 1

Neurosurgical emergency which occurs when the bundle of nerves below the end of the spinal cord are compressed.

Question 2

Cauda equina location

Answer 2

L1-S5
- bundle of lumbar, sacral and coccygeal nerve roots

Question 3

Epidemiology

Answer 3

• Lumbar disc herniation (MC)
• Trauma
• Spinal tumour
• Lumbar spinal stenosis : narrowing of the spinal cord may result in CES. Some causes include spinal osteoarthritis (spondylosis), rheumatoid arthritis, and a slipped vertebra (spondylolisthesis)
• Epidural abscess or haematoma

Question 4

Signs

Answer 4

• Bilateral lower limb weakness and/or reduced sensation
• Decreased or absent lower limb reflexes
• Reduced perianal sensation (S2-S4)
• Palpable bladder due to urinary retention

Question 5

Symptoms

Answer 5

• Lower back pain and sciatica
• ‘Saddle anaesthesia’: numbness in the peri-anal region, groin and inner thighs
• Bladder and bowel dysfunction: urinary retention or incontinence or rarely faecal incontinence
• Leg weakness and difficulty walking
• ED

Question 6

Diagnosis

Answer 6

GOLD STANDARD: MRI SPINE
Bladder USS: determine urinary retention
Consider CT myelography: if MRI CI.

Question 7

DDx

Answer 7

Conus medullaris syndrome: terminal, tapered end of the spinal cord
- Damage to T12- L2
- Upper motor neuron signs (e.g. hyperreflexia and hypertonia)
(CE = hyporeflexia and hypotonia)

Question 8

Treatment

Answer 8

• Emergency decompressive laminectomy : surgery should be performed within 24-48 hours of Sx onset
• Corticosteroids or radiotherapy: CES secondary to malignancy

Question 9

Complications

Answer 9

Complications of delayed presentation or decompression :
- permanent leg weakness,
- sexual dysfunction,
- urinary dysfunction
- chronic pain
DVT :
Post-operative complications :
- Autonomic dysfunction,
- recurrent herniation,
- soft tissue infection
- epidural haematoma