cauda equina syndrome

Question 1

what is cauda equina syndrome (CES)?

Answer 1

a rare but serious condition in which the lumbosacral nerve roots that extend below the spinal cord are compressed

Question 2

in whom is it important to consider CES?

Answer 2

any pt presenting with new/worsening lower back pain

Question 3

what are the implications of a late dx?

Answer 3

permanent nerve damage resulting in long-term leg weakness and urinary/bowel incontinence

Question 4

what is the most common cause of CES?

Answer 4

central disc prolapse

typically at L4/L5 or L5/S1

Question 5

what are the other causes of CES?

Answer 5

• tumours: primary or metastatic
• infection: abscess, discitis
• trauma
• haematoma

Question 6

CES may present in a variety of ways and there is no one sx/sign that can diagnose nor exclude it.

what are the possible features of CES?

Answer 6

• LBP
• bilateral sciatica (50%)
• reduced sensation/pins-and-needles in perianal area
• decreased anal tone
• urinary dysfunction e.g. incontinence, reduced awareness of bladder filling, loss of urge to void

Question 7

what is a late sign in CES and what does it indicate?

Answer 7

incontinence, indicates irreversible damage

Question 8

how is CES investigated?

Answer 8

urgent MRI

to establish specific pathology causing CES and the level of pathology

Question 9

what is the mx for CES?

Answer 9

surgical decompression