Cauda equina syndrome is a rare condition affecting a group of nerve roots in the lower back. The potentially debilitating medical emergency is often difficult to diagnose because the symptoms mimic those of many other lower back conditions. Treatment is available, though lingering symptoms persist in some cases.
The Cauda Equina
The spinal cord ends at the upper portion of the lumbar spine, while the nerves that provide sensory and motor function to the lower body continue along in the spinal canal. The cauda equina is a bundle of these nerves within the lumbar region. Its name is Latin for “horse’s tail,” due to the visual resemblance.
Causes
Compression, trauma, or any kind of damage to this bundle of nerves cause cauda equina syndrome. However, the condition usually results from a herniated disk in the lumbar region. Other possible causes include
- Lumbar spinal stenosis
- Birth and developmental issues
- Spinal tumors or lesions
- Spinal inflammation or infection
- Spinal hemorrhages
- Spinal anesthesia
- Penetrating trauma such as a knife wound or gunshot
- Surgical complications
Symptoms
Cauda equina syndrome symptoms are incredibly similar to those of other lower back conditions and may slowly worsen. Severe lower back pain is common. Pain, sensory loss, or motor weakness in the legs is also typical. Some people develop saddle anesthesia, which is an inability to feel anything in the areas that would normally touch a saddle. Bladder and bowel dysfunction and incontinence are serious signs of cauda equina syndrome. Sexual dysfunction may also occur.
Risk Factors
A few factors may indicate a person’s risk of developing cauda equina syndrome. People who are most at risk of disk herniation are also more likely to have this syndrome. Heavy lifting, being overweight, and older age are also notable risk factors. Some studies indicate that females are more likely to experience cauda equina syndrome than males.
Diagnosis
Diagnosing cauda equina syndrome usually begins with questions about medical history and any recent spine-related trauma. Magnetic resonance imaging (MRI) can produce images of the spinal cord, nerve roots, and surrounding areas to help confirm a diagnosis. In some cases, a myelogram may be necessary. This is an X-ray of the spinal canal after an injection of a contrast dye that can show displacement of the spinal cord or nerves.
Medical History Implications
Certain events in someone’s medical history may also indicate cauda equina syndrome. Violent injuries to the back can lead to a herniated disk. Doctors also look for severe inflammation stemming from inflammatory conditions or infections. Recent lumbar spine surgeries or a history of cancer are also major indicators.
Treatments
In most cases, immediate surgery is the treatment of choice for cauda equina syndrome, to prevent permanent neurological damage. The goal of treatment is to alleviate the underlying cause, usually by removing the pressure on the nerves. People who experience symptoms of this condition should immediately visit a health professional.
Rehabilitation
In addition to treatment for whatever caused cauda equina syndrome, people often need to undergo rehabilitation to regain bladder and bowel control. Pelvic floor exercises can help return control with time. Some people may require catheterization after surgery and during rehabilitation. Glycerin suppositories or enemas can assist with emptying the bowels.
Prognosis
The prognosis of cauda equina syndrome is variable. Without immediate treatment, it can cause permanent incontinence and paralysis. Because of this, many people live with some type of nerve damage even after surgery, and nerve recovery is incredibly slow. Medications can help with long-term pain and counseling helps manage the psychological effects of incontinence, pain, loss of mobility, and sexual dysfunction.
Prevention
Early diagnosis and treatment is the best way to prevent complications of cauda equina syndrome. People experiencing bowel and bladder function changes or a loss of feeling in the groin should immediately seek assistance. Noticeable issues with bladder function include an inability to fully empty the bladder or changes in urine stream. A loss of sensation typically begins as pins and needles and progresses to numbness.