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Cauda Equina Syndrome

Definition

Surgical emergency caused by damage to, or compression of, the cauda equina

 

Risk factors

  • Osteoporosis
  • Metastatic bone cancer
  • Immunosuppression or other infection risk, eg IV drug user
  • Spinal surgery

 

Differential diagnoses

  • Stroke
  • MS
  • Cancer

 

Epidemiology

  • Epidemiology is not well known, is rare
  • Not age related

 

Aetiology

  • Compression of, or damage to, the cauda equina
    • Most common cause is ruptured or slipped/prolapsed disk in lumbar region
    • Stenosis of spinal canal, eg structural deformity
    • Spinal lesion, eg tumour, abscess, infection, inflammation, haemorrhage
    • Fracture
    • Penetrating wound
    • Iatrogenic surgical error

 

Clinical features

  • Sudden onset
  • Diagnosis requires one of:
    • Bladder/bowel dysfunction (present in 60-80% of cases)
    • Sexual dysfunction (sudden onset, may be difficult to notice)
    • Saddle anaesthesia/paraesthesia (change or absence of sensation in groin, genital, anal, inner thigh, ‘saddle’ region)
  • Sharp shooting pain down leg
  • Leg weakness and other focal leg neurology

 

Pathophysiology

  • Damage to the spinal nerves (lumbar and sacral) of the cauda equina results in loss of function, or altered function, to the organs that they supply

 

Investigations

  • Clinical history and examination
  • Imaging
    • CT
    • MRI

 

Management

  • Surgical emergency:  requires surgical intervention – decompression -  by neurosurgeon within 48 hours

 

Prognosis

  • If surgery is not carried out within this timeframe, there is a high chance that the symptoms will not be reversible – ie incontinence, inability to walk, paraesthesia, sexual dysfunction, neuropathic pain
  • Frequent cause of litigation
Cauda Equina Syndrome.docx
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