What is cauda equina syndrome?

From the Guidelines

Cauda equina syndrome is a serious neurological condition that occurs when the nerve roots at the lower end of the spinal cord are compressed, typically due to a herniated disc, tumor, infection, spinal stenosis, or trauma, and requires immediate surgical intervention to prevent permanent nerve damage. This condition is characterized by severe low back pain, sciatica affecting both legs, saddle anesthesia, bladder and bowel dysfunction, and sexual dysfunction. The most frequent finding in cauda equina syndrome is urinary retention, with a sensitivity of 90% 1. The prognosis depends largely on how quickly treatment is initiated, with better outcomes associated with surgery performed within 48 hours of symptom onset. A practical approach to assessment is to do a focused history and physical examination to determine the likelihood of specific underlying conditions and measure the presence and level of neurologic involvement 1. The imaging study of choice in the evaluation of suspected cauda equina syndrome is MRI, which can accurately depict soft-tissue pathology, assess vertebral marrow, and assess the spinal canal patency 1. Some key points to consider in the diagnosis and treatment of cauda equina syndrome include:

• The condition is a medical emergency requiring immediate attention
• Symptoms include severe low back pain, sciatica, saddle anesthesia, and bladder and bowel dysfunction
• Urinary retention is a common finding, with a sensitivity of 90%
• MRI is the imaging study of choice for evaluating suspected cauda equina syndrome
• Prompt surgical intervention is necessary to prevent permanent nerve damage and improve outcomes. In patients with suspected cauda equina syndrome, it is essential to prioritize prompt evaluation and treatment to prevent long-term neurological deficits and improve quality of life 1.

From the Research

Definition and Causes of Cauda Equina Syndrome

• Cauda equina syndrome (CES) is a rare neurological emergency that requires prompt diagnosis and immediate surgical intervention for the best potential patient outcome 2.
• It results from the compression of spinal roots along the lower spine, usually at the level of L2 or below 2.
• The syndrome is typically caused by a large central intervertebral disc herniation or central canal spinal stenosis, but can also occur due to abscesses, neoplasms, and inflammatory conditions 2, 3, 4.

Symptoms and Diagnosis of Cauda Equina Syndrome

• CES typically presents with severe low back pain, pain radiating to lower extremities, motor weakness, sensory loss, saddle anesthesia, bladder and bowel dysfunction 2, 3, 4.
• Red flags and findings consistent with CES include bilateral neurogenic sciatica, reduced perineal sensation, altered bladder function, loss of anal tone, and loss of sexual function 3.
• Diagnosis often involves magnetic resonance imaging (MRI) or computed tomography myelography if MRI is not available 3.
• Postvoid bladder volume assessments can assist in the evaluation of CES 3.

Treatment and Management of Cauda Equina Syndrome

• Treatment relies upon surgical consultation and operative intervention for decompression 2, 3, 4.
• Early diagnosis is crucial to prevent long-term damage to neurological function, and a high index of suspicion is necessary in patients with back and/or leg pain refractory to analgesia, especially in the setting of urinary retention 4, 5.
• Prompt and accurate care of the patient is critical when CES is suspected to minimize permanent nerve damage 6, 5.