Cauda Equina Syndrome

Definition:

• A serious neurological condition due to compression of the cauda equina nerve roots (located at the lower end of the spinal cord).

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.