Cauda equina syndrome is a neurological disorder caused by a lesion of the nerve roots contained in the last portion of the vertebral canal, which runs inside the spinal column.
The cauda equina consists of the terminal nerve roots of the spinal cord covered by the dural sac.
Cauda equina syndrome is frequently the result of lumbar disc herniation. A herniated disc occurs when one of the flexible and soft discs that have the function of elastic cushioning between the bones of the spine, comes out of its usual seat.
The hernia occurs as a result of the rupture of the disc and is linked to aging. The result is that the softer central portion of the disc comes out and causes pressure on the nerve roots of the lumbar spine.
The best spine surgeon in Bangalore is Dr. Satish Rudrappa of Sakra World Hospital who is an expert at micro-surgery aimed at healing this disorder.
The main symptoms of cauda equina are –
- The weakness of the leg muscles, which often turns into an inability to move
- Urinary retention and later loss of sphincter control (urinary and fecal incontinence)
- Erectile dysfunction in men
- Back pain, in the lumbar area, which runs along the legs
The causes can be varied, as is the age of onset. The injury to the nerve roots, in fact, can derive from congenital anomalies or from diseases that occur in adult and old age such as the herniated disc, neoplastic processes, degenerative or inflammatory disorders.
Prognosis is strictly dependent on factors such as the severity and duration of nerve compression. In some patients, it is, therefore, possible to face permanent damage.
Causes of Cauda Equina Syndrome
Cauda equina syndrome is a neurological disorder caused by the compromised nerve roots of the spinal nerves. The anomalies that can cause this include –
- Tumors or masses that compress the cauda,
- Ankylosing spondylitis
- Bone tuberculosis
- Local traumas of the lower spine
- Stenosis (narrowing) of the lumbar canal
The origin of the disorder is varied – it is usually caused by compressions of the nerve roots, but it can also be caused by an inflammation of the arachnoid, one of the membranes lining the central nervous system.
Diagnosis of Cauda Equina Syndrome
Cauda equina syndrome is may prove challenging to diagnose. Its symptoms are similar to those of other diseases. In addition to herniated discs, other conditions manifest themselves with symptoms identical to cauda equina syndrome and include peripheral nerve disorders and spinal cord compression.
A big problem in diagnosing cauda equina syndrome is that its symptoms can be slow to manifest and have differing intensity.
The diagnosis of the cauda equina syndrome is made thanks to the set of the neurological examination and diagnostic imaging tests, which allow to confirm the suspicion and to identify precisely the cause of the disorder.
The neurological physical examination will highlight the set of signs and symptoms previously listed.
During the medical examination, it is also possible to test the Lasègue sign. It is a test that indicates the presence of sciatic nerve suffering.
The patient lies in a supine position, and the doctor extends the patient’s extended leg over the pelvis. This causes a stretching of the sciatic nerve which, if already compressed or irritated, causes sharp pain.
Treatment of Cauda Equina Syndrome
Treatment of cauda equina syndrome is necessary for the recovery of bladder and bowel function. The treatment also serves to reduce further weakness in the lower limbs. If not immediately treated, cauda equina syndrome can cause severe nerve damage.
Those experiencing any of the warning symptoms should be urgently evaluated by a neurosurgeon to set up surgical and non-surgical management of neurological disorders. Urgent surgical treatment is decisive for patients with cauda equina syndrome. Treatment of patients within 48 hours of the onset of the syndrome is essential for the resolution of sensory and motor deficits, as well as urinary and rectal functions.
Even patients who undergo surgery after the ideal window may experience significant improvement. Also, the recovery of bladder function can be delayed compared but will improve continually
Steroids have proven effective in the treatment of spinal cord injuries, and some doctors promote the use of steroids in cauda equina syndrome, there is no scientific evidence to prove this usefulness.