by Kimberly Allen, RN
Cauda equina syndrome or CES is considered a serious neurological condition that in most cases is also a surgical emergency. Damage to this area of your spine causes an acute loss of function in the nerve roots that extend from the end of the spinal cord.
Cauda equina means “horses tail”. The spinal cord extends from your brain to the first lumbar vertebrae in your lower back. A bundle of nerve roots that extend from the end of the spinal cord through the lumbar and sacral vertebrae forms the horses tail or cauda equina. The nerves in the cauda equina are responsible for transmitting signals to and from your muscles as well as other structures in your body. The brain uses these signals to interpret the information being sent from other areas of your body like pain and touch even your sense of position. The brain also uses the out going signals to control muscle movements as well as the function of your organs. Anything that causes compression of or damage to these nerves can cause significant health issues.
Cauda equina syndrome occurs when something causes the spinal canal to narrow significantly compressing the nerve roots. There are a wide variety of things that can lead to CES including a herniated disk. In as many as 15% of the cases CES is caused by a herniated disk. CES that is caused by a herniated disk also occurs more often in men that are 30 to 40 years of age. Another common cause of CES is trauma. Any traumatic event that causes a fracture or partial dislocation of your lumbar area can lead to CES. When there is trauma blood accumulates around the surrounding nerves causing an epidural hematoma. This then leads to compression of the nerve roots in the cauda equina. also, any type of penetrating trauma like a gunshot or stab wound can cause either damage to or compression of the cauda equina. There are numerous other potential causes including spinal stenosis, which is a narrowing of the spinal canal, and tumors either primary or metastatic, as well as long term inflammatory conditions affecting your spine like Paget’s disease or ankylosing spondylitis and infections in your spinal canal.
The symptoms of CES can vary from person to person and in some cases they develop slowly. The symptoms of CES are also similar to other conditions which can make it difficult to diagnose. You should contact your doctor immediately if you experience severe, debilitating pain in your lower back, if you are experiencing numbness and/or weakness in either one or both or your legs that is causing you to have difficulty getting up from a chair or to stumble. Report any loss of or change in sensation in your buttocks, legs, inner thighs, and the backs of your legs or feet especially if is is severe or gets progressively worse. Many people with CES develop problems with the function of their bowel and bladder like incontinence or retention. Some also experience sudden onset sexual dysfunction.
Cauda equina syndrome is a medical and surgical emergency. Left untreated CES can lead to permanent damage including paralysis of your legs and loss of bowel and bladder control as well as numerous other problems. Once the Dr has determined the exact cause of your CES you will usually be treated with aggressive surgical intervention to decompress your spine. If you have an infection you will also be started on IV antibiotics. If your CES is caused by a tumor you may need radiation or chemotherapy after surgery. Depending on the cause of CES some people may require high doses of corticosteroids to reduce swelling. For best results surgical intervention should take place with in 48 hours after your symptoms began. Sometimes even with treatment you may not regain complete function, depending on how much damage was done to the nerves. If there was minimal damage and the surgery is successful it can still take months to years to fully regain control of your bowel and bladder function.