Definition: A serious neurological condition due to compression of the cauda equina nerve roots (located at the lower end of the spinal cord). Cauda Equina Syndrome Etiology: Lumbar disc herniation (most common). Spinal tumours. Spinal stenosis. Trauma, e.g., fractures. Infectious conditions, e.g., abscess. Spinal haemorrhage or haematoma. Iatrogenic causes, e.g., post-operative complications. Clinical Presentation: Severe lower back pain. Bilateral sciatica. Lower limb weakness and/or numbness. Saddle anaesthesia: numbness around the buttocks, perineum, and inner surfaces of the thighs. Bladder and bowel dysfunction (retention, incontinence). Sexual dysfunction. Loss of reflexes in the lower extremities. Investigations: Urgent MRI spine: Gold standard to identify the cause of compression. Clinical examination: Assess tone, power, reflexes, and sensation in lower limbs. Assess perianal sensation and tone. Urinalysis: To rule out urinary retention and infection. Management: Immediate surgical decompression: To prevent permanent neurological damage. Ideally within 48 hours of symptom onset. High dose corticosteroids: Controversial, but sometimes given pre-operatively. Bladder catheterisation: If there’s urinary retention. Physiotherapy and rehabilitation post-operatively. Prognosis: Varies depending on the duration of compression before treatment and severity of symptoms. Earlier treatment typically results in a better prognosis. Complications: Persistent bladder, bowel, and sexual dysfunction. Chronic pain. Permanent motor and sensory deficits.
