Cauda equina syndrome is a uncommon but critical low back disorder that requires emergency and possibly surgical intervention. In the lumbar spine there is a bundle of nerves that extend down the spinal cord which in turn affect the sensation and movement of the legs. Because of the separation of the nerves into separate bundles with string like appearance the cauda equina looks like a horse’s tail. This bundle of nerves in turn supplies the legs with signals to control the muscles and provide sensation. Symptoms of Cauda Equina include: limited or no bowel or bladder control, pain and sensation loss in the anal region, groin, buttocks and inner thighs, numbness/weakness that is along one or both legs as well as changes in sexual function.
There are varying causes which narrow the spinal canal which causes compression of the nerves all of which could be due to a very large herniated disc impinging the spinal cord, spinal tumor, or lumbar spinal stenosis, inflammatory spine conditions (such as ankylosing spondylitis) and/or spinal canal infections (spinal epidural abscess). Various form of trauma such as car accidents, falling form height and or gunshot/knife wounds.
First it is of important to complete an extensive physical and neurological evaluation with review of the range of motion, reflexes, strength, balance and even anal sphincter muscle evaluation. Tests such as lumbar x-ray, MRI and/or CT scan or even a myelogram (consists of dye injection into the space around the nerves) which would indicate a nerve impingement by prevention of dye flow to the impacted area. It is important to relieve the pressure on the nerves. Emergency surgical decompression is done to relieve any pressure from the nerve. It has been indicated that obtaining surgery within 24 to 48 hours is best way to achieve optimum sensory, motor deficit and bladder/bowel functioning.