From the Guidelines
Cauda equina syndrome is a rare medical condition characterized by the compression of the sacral and lumbar nerve roots within the vertebral canal, resulting in impairment of bladder, bowel, or sexual function, and perianal or saddle numbness, requiring immediate diagnosis and treatment to prevent permanent nerve damage. This condition typically presents with a combination of symptoms, including:
- Low back pain with or without radicular symptoms
- Weakness in the lower limbs
- Sensory changes or numbness in the lower limbs
- Absent lower limb reflexes
- Bladder and/or bowel dysfunction
- Sexual dysfunction The most common cause of cauda equina syndrome is lumbar disc herniation at the L4-L5 and L5-S1 levels, although other etiologies such as neoplasm, infection/inflammation, spinal stenosis, and hemorrhage can also be responsible 1.
The imaging study of choice for evaluating suspected cauda equina syndrome is MRI, specifically MRI lumbar spine without IV contrast, due to its ability to accurately depict soft-tissue pathology and assess spinal canal patency 1. Urgent MRI assessment is recommended in all patients presenting with new-onset urinary symptoms in the context of low back pain or sciatica. In cases where underlying malignancy, infection, or inflammation is clinically suspected, MRI lumbar spine without and with IV contrast may be helpful in delineating the etiology of cauda equina syndrome 1.
Prompt surgical intervention, typically within 24-48 hours of symptom onset, is crucial to prevent permanent nerve damage and improve outcomes 1. The prognosis of cauda equina syndrome largely depends on the timing of treatment initiation, with earlier intervention associated with better outcomes. Therefore, anyone experiencing symptoms of cauda equina syndrome should seek emergency medical attention immediately.
From the Research
Definition and Causes of Cauda Equina Syndrome
- Cauda equina syndrome is a rare but serious condition characterized by compression of the cauda equina nerve roots, most commonly caused by lumbar disc herniation 2, 3, 4, 5, 6.
- The syndrome can result from various conditions that compress the nerves in the lumbosacral spinal canal, leading to sensory loss, motor weakness, and bowel and bladder dysfunction 3, 6.
Symptoms and Diagnosis
- Common symptoms of cauda equina syndrome include lower back pain, sciatica, bladder dysfunction, saddle anesthesia, and bowel dysfunction 2, 3, 4, 5, 6.
- Red flag symptoms, such as bilateral neurogenic sciatica, reduced perineal sensation, and altered bladder function, should lead to a high clinical suspicion of cauda equina syndrome 2, 4.
- Diagnosis is often delayed, and a thorough history and physical exam, followed by magnetic resonance or computed tomography imaging myelogram, are essential for accurate diagnosis 4, 6.
Treatment and Management
- Urgent surgical decompression is usually recommended for the best outcomes, to reduce morbidity and complication rates 2, 3, 4, 6.
- Immediate magnetic resonance imaging, within 1 hour of presentation to the emergency department, is crucial in patients with suspected cauda equina syndrome to allow prompt diagnosis and treatment 2.
- Early diagnosis and treatment are imperative for optimal outcomes, and delays in diagnosis can have devastating and life-changing consequences for patients 5, 6.