Cauda Equina Syndrome

Cauda Equina Syndrome

 


This is a 'Spinal Emergency'. It occurs when the nerves below the spinal cord are compressed. The nerves that supply the bladder and bowels also supply sensation to the skin around the bottom and back passage.

 

The syndrome is a complex spectrum of symptom and signs. If the clinical index of suspicion is even moderate the diagnosis is confirmed with MRI scan

 

SYMPTOMS                          Perineal numbness                 Unilateral or bilateral

Disturbance of bladder function

                                                Sphincter dysfunction            Bowel or bladder

                                                Back pain                                Severe

                                                Sciatica                                   Unilateral or bilateral

 

SIGNS                                     Perineal numbness                 Unilateral or bilateral

                                                Retention of urine

Incomplete emptying of bladder (post micturition residual or bladder ultrasound greater than 50ml)

Loss of sensation of passing urine

                                                Motor loss or reflex loss

                                                Loss of voluntary anal sphincter contraction

 

Perineal numbness and any other symptom or sign requires specialist referral

 

The exclusion of a surgically treatable cause can often only be made with specialist imaging, most commonly an MRI scan.

 

Many patients delay in presentation to health care professionals as they do not recognise the significance of their symptoms. Further delay in obtaining specialist spinal care can result in devastating disability which can lead to medical negligence litigation.

 

Timely referral after thorough assessment may result in better outcomes for patients.  

 

Spinal Pain alone can produce pain inhibition of bladder function and so early adequate analgesia is important and aids assessment.

 

The literature currently suggests the outcome of surgical decompression is better if decompression occurs WITHIN 48 HOURS OF THE ONSET OF SYMPTOMS. Most surgeons would prefer to carry out surgery as soon as it is safe to do so , if surgery is required.  

 

This condition requires emergency referral to the secondary care specialist that can confirm the diagnosis and treat the condition.

 

PATIENT INFORMATION



 


If you have significant back pain or sciatica, and numbness around the bottom area or back passage you are at risk of developing cauda equine syndrome. It is rare, between 6-10 per million population. It is a diagnosis that doctors are happy to see and assess if only to re-assure.



 


If you have numbness around the anus or back passage  and any alteration of control of bladder function or bowel function you should be assessed urgently by some one of suitable training and experience to reassure you or to arrange suitable urgent tests such as an MRI scan.



 


CAUDA EQUINA WEBSITES