Cauda Equina Syndrome Overview



Cauda Equina Syndrome:

 • Prevalence: 1:33,000-100,000 ppl/yr

 • Incidence: 1.5-3.4 million ppl/yr

 • Urgent condition due to severe compression of nerve roots of lumbar spine

 • MCC- acute lumbar disc herniation

 • Involves lumbar spine L1-L5



Symptoms - Cauda equina syndrome (CES) is usually characterized by these so-called ‘red flag’ symptoms:

 • Severe low back pain (LBP)

 • Sciatica: often bilateral but sometimes absent, especially at L5/S1 with an inferior sequestration

 • Saddle and/or genital sensory disturbance

 • Bladder, bowel and sexual dysfunction

SPINE Mnemonic:

 • S - Saddle anesthesia

 • P - Pain

 • I - Incontinence

 • N - Numbness

 • E - Emergency



Causes of Cauda Equina Syndrome:

 • large lower lumbar disc herniation, prolapse or sequestration

 • epidural hematoma

 • infections

 • primary and metastatic neoplasms

 • trauma

 • post surgical

 • prolapse after manipulation

 • after chemonucleolysis

 • after spinal anaesthesia

 • ankylosing spondylitis

 • gunshot wounds

 • constipation



Differential Diagnosis:

 • Spinal cord infarct

 • HIV related myelopathy

 • Transverse myelitis

 • Multiple sclerosis

 • Syringomyelia

 • Spinal AVM

 • Multilevel lumbar stenosis

 • Vascular intermittent Claudia toon

 • Spinal infection/abscess

 • Ankylosing spondylitis

 • Tethered cord

 • Guillain-Barre syndrome

 • Neurosarcoidosis

 • Multiple sclerosis

 • Diastematomyelia



Physical Exam:

 • Inspection

	- lower extremity muscle atrophy

 • Palpation

	- lower back pain/tenderness is not a distinguishing feature

	- palpation of the bladder for urinary retention

 • Neurovascular Examination

	- bilateral or unilateral lower extremity weakness and sensory disturbances

	- decreased or absent lower extremity reflexes

	- reduced or absent sensation to pinprick in the perianal region (S2-S4 dermatomes), perineum, and posterior thigh

	- decreased rectal tone or voluntary contracture

 • Provocative Tests

	- diminished or absent bulbocavernosus reflex

	- diminished or absent anal wink test

	- reflex contraction of the external anal sphincter upon pinprick stimulation of skin around the anus



Laboratory studies:

 • CBC, ESR, CRP

 • Urodynamic studies (PVR)



Imaging studies:

 • MRI- Sagittal, axial T1 and T2



Treatment:

 • Surgical decompression



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