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Understanding Cauda Equina Syndrome

3D rendering of body with severe lower back pain

Muscle related back pain is common, but lower back pain and inner thigh numbness, incontinence, or urinary retention, can be caused by a medical emergency known as cauda equina syndrome. Centers for Neurosurgery, Spine & Orthopedics (CNSO) is a multi-specialty provider of comprehensive medical care for brain, nerve, and spine afflictions. The CNSO team is trained to diagnose and treat a wide range of spinal problems, including disc disorders, spinal tumors, and conditions like cauda equina syndrome. Learn more about cauda equina syndrome treatment available at CNSO for patients throughout northern New Jersey.

What Is Cauda Equina Syndrome?

Cauda equina syndrome (CES) is a rare neurosurgical condition that is a medical emergency that must be treated within 24 hours. It results from compression of the cauda equina, which is the many small nerves and nerve roots at the base of the spinal cord. These nerves which freely float in the cerebrospinal fluid appear similar to the tail of a horse, hence the Latin name of “horse’s tail”. The cauda equina nerves supply sensory and motor functions to the legs and the bladder.

When any of the cauda equina nerves are compressed, as occurs in cauda equina syndrome, their function is disrupted. This causes symptoms of bladder and bowel dysfunction as well as leg weakness or loss of function. Cauda equina syndrome, if not rapidly treated can result in permanent muscle paralysis in one or both legs and of the bladder and bowel sphincters. There are two types of cauda equina syndromes:

  • Acute cauda equina syndrome: Severe symptoms appear suddenly, and patients likely will need surgery within 4 hours.
  • Chronic cauda equina syndrome: Patients have failed to be treated and are left with permanent disfunction of their, bladder, bowel, and loss of leg function. They can no longer stand or walk

Emergency surgery is necessary to prevent progression to permanent damage. Surgery is the only treatment for Acute cauda equina syndrome. There is no cure for chronic cauda equina syndrome, only management of the symptoms.

Cauda Equina Syndrome Signs and Symptoms

The symptoms of cauda equina syndrome often develop quickly and affect the lower extremities. The most common symptom of cauda equina syndrome is a bladder problem known as urinary retention. Urinary retention means that the patient’s bladder fills with urine normally, but they cannot empty it completely when they urinate. Other signs and symptoms include:
  • Severe low back pain
  • Bowel dysfunction such as incontinence (lack of control)
  • Pain radiating down the legs (sciatica)
  • Muscle weakness or sensory loss in both legs
  • Loss of motor function in legs
  • Loss or reduction of reflexes
  • Sexual dysfunction
  • Saddle anesthesia (a sensory disturbance causing numbness around the buttocks and genital area)
The symptoms and severity that each patient experiences depend on which nerve roots are compressed. CES can be divided into two classifications based on symptoms:
  • Complete cauda equina syndrome (CES-R): This type causes symptoms such as urinary retention and bowel incontinence and affects about 60% of patients.
  • Incomplete cauda equina syndrome (CES-I): This type causes symptoms other than retention or incontinence, such as loss of urgency or increased urgency in the bladder and bowels.
The type of cauda equina syndrome the patient has will determine the best treatment option.

Cauda Equina Syndrome Causes

Cauda equina syndrome results from a pre-existing spinal condition or trauma that causes the cauda equina nerves to be compressed and their function to be interrupted. The most common cause is a herniated disc in the lumbar spine (lower back). A herniated disc occurs when part of the spine (disc) moves out of position and puts pressure on surrounding nerves. Other causes of cauda equina syndrome include:
  • Congenital birth defects or anomalies
  • Lumbar spinal stenosis
  • Traumatic injuries to the lower back, like from a motor vehicle accident, fall, or gunshot wound
  • Postoperative lumbar spine surgery complications
  • Spinal arteriovenous malformations (AVMs)
  • Spinal hemorrhages
  • Spinal infections or inflammation
  • Spinal lesions or tumors
Not everyone with one of these conditions will develop cauda equina syndrome but having one of these symptoms can increase the chances of developing it. Other general risk factors for developing cauda equina syndrome are not exactly known. However, researchers suspect that factors such as being 30+ years old, being overweight, or working a strenuous job may influence the risk.

Diagnosing Cauda Equina Syndrome

Diagnosing cauda equina syndrome can be difficult for a variety of reasons. The associated symptoms can come on suddenly or evolve over time, and similar symptoms may be caused by other conditions. However, it is essential to get diagnosed and treated swiftly to treat cauda equina syndrome. A doctor uses the following methods to determine a diagnosis of cauda equina syndrome:

Physical Examination

A physical exam is used to test the patient’s motor and sensory skills, as well as their stability, strength, reflexes, alignment, and movement abilities. The patient may be asked to sit, stand, bend, lie down, lift their legs, and perform other motions to see how they are able to move. Doctors also may check muscle tone and order blood tests during the exam.

Imaging Scans

Imaging scans are needed to determine if the problem is cauda equina syndrome, and if so, what is causing it. Some common imaging tests are:
  • Magnetic resonance imaging (MRI):MRIs provide three-dimensional images of the spine and surrounding tissues using magnetic fields.
  • Myelogram: This special X-ray procedure involves injecting a liquid dye into the spinal column and taking images to determine where the pressure on the cauda equina originates.
  • Computerized tomography (CT) scan: CT scans provide an x-ray of the spinal canal that offers definition of the bone, but this method is not very helpful for visualizing discs.
MRIs are the preferred method for detecting cauda equina syndrome because of the detailed imaging of the tissue they provide. Once a doctor confirms a diagnosis of cauda equina syndrome, surgery by a neurosurgeon or orthopedic spine surgeon is required urgently to ensure the best possible prognosis for the patient.

Cauda Equina Syndrome Treatment Options

Cauda equina syndrome is considered a medical emergency because patients can experience permanent damage if they do not receive treatment quickly. The best treatment option is emergency decompression surgery within less than 24 hours of acute symptoms appearing to remove whatever is compressing the nerves. Undergoing surgery early offers the best chance for improvement of sensory, muscle, bowel, and bladder function. Centers for Neurosurgery, Spine & Orthopedics generally approaches treatment in a conservative manner, often trying minimally invasive methods such as pain management and physical therapy for treatment first. However, when patients have medical emergencies like cauda equina syndrome, CNSO is also prepared to provide urgent spine surgeries to prevent permanent damage and provide the best outcome possible.

Cauda Equina Syndrome Recovery

Surgery for cauda equina syndrome may not immediately result in improved function, especially in the bladder. It may take time to see full recovery of the bladder, but patients often use a mix of medications and intermittent self-catheterization of the bladder to help manage until they are fully recovered. Some patients may not fully recover from the damage caused by cauda equina syndrome if it is permanent, and this can be bothersome and distressing. The good news is lifestyle changes and support measures can help, including taking medications, attending physical therapy, or going to counseling.

Cauda Equina Syndrome Treatment at CNSO

Centers for Neurosurgery, Spine & Orthopedics takes a team approach to spine and brain treatment to offer patients the best quality care. The CNSO team is made up of trained specialists who work together in an interdisciplinary approach, including neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists. Some of the benefits CNSO offers our patients include:
  • Multiple locations throughout northern New Jersey in Bergen, Passaic, Essex, Hudson, and Morris counties
  • Personalized treatment plans backed by medically proven, evidence-based practices
  • Fluency in multiple languages, including Spanish, Korean, Russian, Mandarin Chinese, Hebrew, and more
  • State-of-the-art equipment
  • Surgical and non-surgical treatment options
  • Telemedicine appointments
These benefits are some of the reasons patients in northern New Jersey choose Centers for Neurosurgery, Spine & Orthopedics for their medical care.

Trust CNSO for Cauda Equina Syndrome Treatment

Patients experiencing any signs and symptoms of cauda equina syndrome should contact their doctor immediately. At Centers for Neurosurgery, Spine & Orthopedics, the trained multi-specialty team provides diagnosis and treatment for brain, spine, and nerve problems, including rare conditions like cauda equina syndrome, to patients throughout northern New Jersey. Contact us today to request an appointment or learn about the other conditions CNSO treats.
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