Cauda Equina Syndrome
Cauda equina is the collection of nerves at the very end of the spinal cord. When the cauda equina was damaged and compressed causing pain and numbness sensation, we call it “Cauda Equina Syndrome” (CES).
CES is very rare which only account for 1 in 2000 of lower back pain patients. However, if health practitioners failed to diagnosis CES, this will cause serious consequence to patient’s bladder, bowel, and sexual function.
The major cause of CES is a large lumbar disc herniation at immediate vicinity of L2 or below, which compresses the cauda equina. Infections such as meningitis can also lead to CES. Moreover, sacral fracture can also cause CES when it compresses the cauda equina.
The signs and symptoms of CES can be universal to other chronic disease. Common signs reported from patients are low back pain, unilateral or bilateral sciatica, motor weakness in lower extremities, and/or numbness around the buttock area. With regards to bladder and bowel dysfunction, it may not present in the early stage.
CES can be present acutely or chronically. With acute CES, patient may present sudden back pain with dramatic sensory changes around the buttock area, and possible weakness in urination. During chronic CES, previous symptoms mentioned will build up gradually or may fluctuate over weeks, months or even years. If the patient had slow onset of bladder and bowel dysfunction, it will present with increase severity and less responsive to management.
Health practitioners and patients should monitor the red flag to CES such as bladder dysfunction and numbness tingling between legs and around the anus if the patient have continuous back pain, sciatica, and increase urinary frequency and urgency.
When patient has diagnosis with CES, surgery is the first option to prevent further neurological damage. Study had found significantly improvement in neurological outcome if patient had surgical operation within 24 hours of onset compare to 48 hours. Some patient may also be able to regain bladder continence if they have surgery within the 24 hours to 48 hours timeframe. Therefore, surgery should be done as soon as CES was diagnosed.
The goal of the surgery is to decompress any compressed lesions to improve sensory and motor deficits. However, some patient may still experience some degrees of neurological deficit.