cauda equina syndrome

Question 1

what is cauda equina syndrome?

Answer 1

compression of the cauda equina region of the spinal cord where the lower motor neurones of L1-S5 pass through

Question 2

what can cause cauda equina syndrome?

Answer 2

• disc herniation, commonly at L5/S1 or L4/L5
• trauma
• neoplasm, either primary or metastatic
• infection e.g discitis
• chronic spinal inflammatiojn e.g ankylosing spondylitis
• Iatrogenic

Question 3

what are the clinical features of cauda equina syndrome?

Answer 3

• lower motor neurone signs and symptoms
• reduced lower limb sensation usually bilateral
• bladder/bowel dysfunction (asses if in retention)
• lower limb motor weakness
• severe back pain
• impotence
• saddle anaesthesia
• loss of anal tone
• make sure you do a PR exam and post void bladder scan for suspected CES.

Question 4

how is cauda equina syndrome classfied?

Answer 4

• CES with retention: back pain with unilateral/bilateral sciatica, lower limb motor weakness, saddle parasthesia, loss of anal tone and urinary control
• Incomplete CES - above, but altered urinary sensation e.g loss of desire to void, diminished sensation and poor stream
• Suspected CES - severe back and leg pains with variable neurological signs and symptoms. voiding issues suggest sphincter disturbance

Question 5

what investigations are done for CES?

Answer 5

whole spine MRI

further imaging may be required depending on underlying cause.

Question 6

how is CES managed?

Answer 6

• early neurosurgical review for ugent decompression
• high dose steroids to reduce localised swelling
• immobilise in cases of trauma
• surgical decompression if appropriate
• cases of malignancy, radiotherapy/chemo can be used, especially if the patient is unfit for surgery.

Question 7

what age group is CES most common in?

Answer 7

40-50