All About Cauda Equina Spinal Cord Injury
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Cauda Equina Syndrome Definition and Facts
Cauda equina syndrome an abnormal sensation of the body (paraesthesia), for example, numbness, tingling, or burning, and is an extreme version of nerve compression or inflammation.
Nerves that branch off of the spinal cord (also called nerve roots) are an extension of the spinal cord and are responsible for sending signals to and from the muscles and other structures throughout the body. These signals allow the brain to interpret information from the body including pain, touch, and sense of position. Outgoing signals allow the brain to control actions of the organs and muscle movements.
Cauda equina syndrome is a serious medical emergency, and compression of the nerves in the lower portion of the spinal canal causes it, and if left untreated it can lead to permanent loss of bowel and bladder control, paraesthesia, and paralysis of the legs.
Causes of cauda equina syndrome include:
inflammatory and infectious conditions, and
accidental medical intervention.
In cauda equina syndrome compression or inflammation of the nerve roots can cause symptoms of;
decreased strength, and
Below is a list of some of the things to be aware of:
When Should You Go to the ER for Cauda Equina Syndrome?
Cauda Equina Syndrome is a surgical emergency. Persons should seek immediate medical care or go to the emergency department if they believe they have symptoms of Cauda Equina Syndrome. Some of the early symptoms related to cauda equina syndrome, including low back pain and muscle weakness, are more often caused by simple disk herniation, which does not require urgent attention. However, if you develop severe pain or loss of sensation or bowel or bladder disturbances, you should contact your physician immediately. Your chances of regaining normal function and having a positive outcome are related to how long you have had symptoms of cauda equina syndrome. Most experts agree that people with cauda equina syndrome should undergo surgery to make more space for the nerves (lumbar decompression) within 48 hours in order to have the best chance for complete recovery.
What Questions Should You Ask the Doctor about Cauda Equine Syndrome?
People with the symptoms described above should be seen and evaluated by their doctor to determine if they have cauda equina syndrome. People should ask their doctor to determine the cause of their symptoms (such as disk herniation or spinal stenosis). People with symptoms similar to those previously mentioned who do not have Cauda Equina Syndrome should ask their doctor for treatment recommendations and for further warning signs to watch for the development of Cauda Equina Syndrome.
What Tests Diagnose Cauda Equina Syndrome?
The initial diagnosis of cauda equina syndrome is made based on findings from the individual's history, symptoms, and physical exam. The physical exam includes testing muscle strength of the lower extremities, evaluating sensation to touch and pain, especially around the groin (perineum), checking the lower extremity reflexes, and evaluating rectal tone, sensation, and reflex. Imaging studies helpful in the diagnosis include plain x-ray films of the lower back to assess for evidence of trauma or severe arthritis (degenerative changes). MRI with and without contrast provides a detailed look at tumors, infection, intervertebral disks, and nerve roots. This study allows the doctor to determine if the nerves are being compressed, to what degree, and by what structures. Findings from these studies help the surgeon plan the appropriate treatment. Not all people with back pain and/or leg pain and changes in bowel or bladder function have cauda equina syndrome. More common causes of bladder changes are urinary tract infections, which can be identified by a simple urine test, and diabetes, which can be identified with blood tests.
What Is the Recovery Time After Surgery for Cauda Equina Syndrome, Is It Disabling?
In many cases of Cauda Equina Syndrome, emergency decompression of the spinal canal is the best treatment option. The goal is to relieve pressure on the nerves of the cauda equina by removing the compressing structures and increasing the space available for the nerves in the spinal canal. Traditionally, Cauda Equina Syndrome has been considered a surgical emergency, with surgical decompression considered necessary within 48 hours of the onset of symptoms. For people with a herniated disk as the cause of cauda equina syndrome, removal of a portion of the bone surrounding the nerves (laminectomy) is performed and the disk material compressing the nerves is removed (discectomy). Many clinical and experimental reports have presented data on the functional outcome based on the timing of surgical decompression. Some investigators have reported no significant differences in the degree of functional recovery as a function of the timing of surgical decompression. Even with these findings, however, most investigators recommend surgical decompression as soon as possible following onset of symptoms to offer the greatest chances of complete neurologic recovery. Many clinical and experimental studies have investigated patient outcomes in relation to the timing of surgical decompression. Some investigators have reported no significant differences in the degree of functional recovery as a function of the timing of surgical decompression. Even with these findings, however, most investigators recommend surgical decompression as soon as possible following the onset of symptoms to offer the greatest chances of complete neurologic recovery. Investigators have attempted to identify specific criteria that can aid in predicting the outcome of persons with Cauda Equina Syndrome.
*People with pain in both legs (bilateral sciatica) have less chance or full recovery than persons with single leg pain (unilateral sciatica).
*People with complete groin numbness (perineal anesthesia) are more likely to have permanent paralysis of the bladder.
*The extent of groin numbness (perineal or saddle sensory deficit) is the most important predictor of recovery.
Do You Need to Follow Up with Your Doctor after Being Treated for Cauda Equina Syndrome?
Persons with Cauda Equina Syndrome should have close follow-up with their surgeon to monitor any changes in function. Early surgery gives the patient the best chance for complete recovery from cauda Cauda Equina Syndrome.