CAUDA EQUINA SYNDROME

Overview and Facts

Cauda Equina Syndrome refers to the group of nerve fibers formed by five fibers, each from the lumbar and sacrum and one tissue from the coccygeal nerve. The name was coined from its similarity with the tail of a horse. The primary purpose of such structure is to provide a pathway for the impulses from the lower extremities to the essential organs of the genitourinary, lower gastrointestinal tract, and the reproductive system.

The Cauda Equina Syndrome occurs when these nerves are subjected to extreme pressure that impinges the network of fibers brought about by the destruction of the lumbar area secondary to trauma, presence of mass, or narrowing of the vertebral canal secondary to infection. Cauda equine is an essential structure since any abnormality that occurs and affects this structure can result in dysfunction of urination and passing out of the stool, among others. 

Types and Symptoms

TYPES

There are two classes of cauda equina syndrome, and these are: 

  • Cauda Equina Syndrome- R (CES-R)- where there is a significant amount of urine or feces being retained in the bladder or on the rectum. This type appears to be irreversible.
  • Cauda Equina Syndrome- I (CES- I)- In this type, there is only an incomplete voiding and defecation. It is also the type that is reversible if the surgical intervention can be done within 48 hours after the symptoms have appeared.

SYMPTOMS

Initial presenting symptoms are non- specific and can be mistaken for something else. A thorough investigation is warranted to rule out and arrive at a correct diagnosis. 

Symptoms include: 

  • Excruciating pain in the lower back
  • Loss or difference in the sensation of the lower extremities that brings about the difficulty in shifting from one position to another
  • Sudden onset of incomplete bladder emptying 
  • A decrease in sexual urge.

Diagnosis & Medications

DIAGNOSIS

On the initial visit to the doctors’ clinic, a thorough history and physical examination are made to narrow down the differential diagnosis into a Cauda Equina syndrome. In addition to this, the medical practitioner may request for either of the following:

  • A computed tomography scan
  • A myelogram- A procedure that involves the examination of the spinal nerves by use of an x-ray machine, a fluoroscope after the dye is instilled in the subarachnoid space.
  • Magnetic Resonance Imaging (MRI)- used to view the spine in a three-way perspective (length, breadth, and depth)

TREATMENT

Once the diagnosis of the cauda equine syndrome is made and its cause determined. Any of the following can be used to treat the underlying condition:

  • Surgical resection – As previously stated, CES-I needs a quick surgical procedure to reverse the symptoms exhibited by the patient and to prevent further damage to the organs affected.
  • Medical treatment- involves the use of steroids because these drugs reduce inflammation
  • Antibiotic therapy-  This is necessary to treat the infectious focus of the CES
  • Use of chemotherapeutic agents- this is usually administered to persons who have had removal of the tumor, but the minute metastasis has not been excised.

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