From the Guidelines
Yes, a spinal type can show cauda equina syndrome, particularly when there is compression of the sacral and lumbar nerve roots within the vertebral canal, as evidenced by studies such as 1.
Key Points to Consider
- Cauda equina syndrome (CES) is a rare condition that results from dysfunction of the sacral and lumbar nerve roots, producing impairment of bladder, bowel, or sexual function and perianal or saddle numbness, as described in 1.
- The most common cause of CES is lumbar disc herniation at the L4-L5 and L5-S1 levels, but other etiologies include neoplasm, infection/inflammation, spinal stenosis, and hemorrhage, as outlined in 1.
- Symptoms of CES include back pain with or without radicular symptoms, weakness in the lower limbs, sensory changes or numbness in the lower limbs, or absent lower limb reflexes, as reported in 1.
Diagnostic Approach
- The imaging study of choice in the evaluation of suspected CES is MRI because of its ability to accurately depict soft-tissue pathology, assess vertebral marrow, and assess the spinal canal patency, as recommended in 1.
- MRI lumbar spine without IV contrast is most useful in the evaluation of suspected CES, and a prospective cohort study by Bell et al, cited in 1, recommends urgent MRI assessment in all patients who present with new-onset urinary symptoms in the context of LBP or sciatica.
- Although MRI is superior, CT lumbar spine without IV contrast can answer the question of whether or not cauda equina compression is present, and a recent retrospective review cited in 1 showed that 50% thecal sac effacement on CT predicted significant spinal stenosis.
From the Research
Cauda Equina Syndrome and Spinal Types
- Cauda equina syndrome (CES) is a condition that occurs when the nerve roots in the lumbar spine are compressed, leading to a range of symptoms including lower back pain, bladder dysfunction, and sciatica 2, 3.
- The compression of nerve roots can be caused by various factors, including lumbar disc herniation, which is the most common cause of CES 3.
- CES can be a complication of spinal anesthesia, as seen in a case report where a patient developed CES after undergoing spinal anesthesia for a surgical procedure 4.
- The diagnosis of CES requires prompt and accurate assessment, including the use of magnetic resonance imaging (MRI) to confirm the compression of nerve roots 3, 5.
- Urgent decompressive surgery is usually recommended for the best outcomes in patients with CES, to reduce morbidity and complication rates 3.
Symptoms and Diagnosis
- The symptoms of CES can include bladder dysfunction, saddle anesthesia, and sciatica, which should lead to a high clinical suspicion of the condition 3, 5.
- Red flag symptoms, such as bladder dysfunction and saddle anesthesia, should prompt immediate investigation and treatment 3.
- The British Association of Spinal Surgeons has published an updated standard of care for patients with CES, which includes immediate MRI and urgent decompressive surgery 3.
- A practical guide to the assessment and early management of patients with suspected CES has been developed, which includes a focus on communication, documentation, and safety netting those at risk 6, 5.
Treatment and Management
- The treatment of CES typically involves urgent decompressive surgery to relieve the compression of nerve roots 3.
- The use of medications, such as pregabalin, tramadol, and dexamethasone, may also be necessary to manage symptoms and reduce inflammation 4.
- Early detection and treatment of CES are essential to minimize the risk of permanent damage and improve outcomes for patients 4, 3, 6.