Cauda Equina Syndrome Overview

Low back pain is very common. It affects millions of people. In most cases, you don't need surgery for low back pain. But in rare cases, severe back pain can be a sign of cauda equina syndrome (CES), a condition that usually requires urgent surgical treatment. People with cauda equina syndrome often are admitted to a hospital as a medical emergency. Here's what you need to know about cauda equina syndrome.

What Is Cauda Equina Syndrome?

Cauda equina syndrome is a rare disorder that usually is a surgical emergency. In patients with cauda equina syndrome, something compresses on the spinal nerve roots. You may need fast treatment to prevent lasting damage leading to incontinence and possibly permanent paralysis of the legs.

CES affects a bundle of nerve roots called cauda equina (Latin for horse's tail). These nerves are located at the lower end of the spinal cord in the lumbosacral spine. They send and receive messages to and from your legs, feet, and pelvic organs.

Causes of Cauda Equina Syndrome

CES occurs more often in adults than in children. But it can occur in children who have a spinal birth defect or have had a spinal injury.

These are the most common causes of cauda equina syndrome:

• A severe ruptured disk in the lumbar area (the most common cause)
• Narrowing of the spinal canal (stenosis)
• A spinal lesion or malignant tumor
• A spinal infection, inflammation, hemorrhage, or fracture
• A complication from a severe lumbar spine injury such as a car crash, fall, gunshot, or stabbing
• A birth defect such as an abnormal connection between blood vessels (arteriovenous malformation)

Symptoms of Cauda Equina Syndrome

It may be hard to diagnose cauda equina syndrome. Symptoms vary and may come on slowly. They also mimic other conditions. If you have any of these symptoms, see your doctor right away:

• Severe low back pain
• Pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair
• Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet that is severe or gets worse and worse; you may experience this as trouble feeling anything in the areas of your body that would sit in a saddle (called saddle anesthesia)
• Recent problem with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it (incontinence)
• Sexual dysfunction that has come on suddenly

Diagnosing Cauda Equina Syndrome

A doctor can diagnose cauda equina syndrome. Here's what you may need to confirm a diagnosis:

• A medical history, in which you answer questions about your health, symptoms, and activity
• A physical exam to assess your strength, reflexes, sensation, stability, alignment, and motion. You may also need blood tests
• Magnetic resonance imaging (MRI) scan, which uses magnetic fields and computers to produce three-dimensional images of your spine
• A myelogram -- an X-ray of the spinal canal after injection of contrast material -- which can pinpoint pressure on the spinal cord or nerves
• A computed tomography (CT) scan

Treating Cauda Equina Syndrome

If you have cauda equina syndrome, you'll need prompt treatment to relieve pressure on nerves. Surgery must be done quickly to prevent permanent damage, such as paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems. It is best if this occurs within 48 hours of the onset of symptoms. Depending on the cause of your CES, you may also need high doses of corticosteroids. These can reduce swelling. If you are diagnosed with an infection you may need antibiotics. If a tumor is responsible, radiation or chemotherapy may be needed after surgery.

Even with treatment, you may not retrieve full function. It depends on how much damage has occurred. If surgery is successful, you may continue to recover bladder and bowel function over a period of years.

Living With Cauda Equina Syndrome

If permanent damage has occurred, surgery cannot always repair it. Your cauda equina syndrome is chronic. You will need to learn ways to adapt to changes in your body's functioning. You'll find that both physical and emotional support is essential.

Try to involve your family in your care. Many professionals can also provide you support. Depending on your limitations, you can seek help from:

• An occupational or physical therapist
• A social worker
• A continence advisor and continence physiotherapists
• A sex therapist

And, as with many conditions, there may be nothing quite as helpful as support from those who really understand what you're going through. That's why joining a cauda equina support group may be a good idea.

If you have loss of bladder or bowel function, the following tips may help:

• Use a catheter to completely empty your bladder three or four times a day.
• Drink plenty of fluids and use good personal hygiene to prevent urinary tract infections.
• Check for waste and clear the bowels with gloved hands. If needed, use glycerin suppositories or enemas.
• Wear protective pads and pants to prevent leaks.

Also, ask your doctor about medication for help with pain, as well as bladder and bowel problems.

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