Cauda equina syndrome is a rare but potentially serious neurological disorder caused by pressure on the cauda equina, a bundle of nerves and nerve roots in the lumbar region at the base of the spine. The pressure causes symptoms such as bowel and bladder dysfunction and numbness and weakness in the muscles and nerves of the legs.
Cauda equina syndrome is a medical emergency that, if left untreated, can cause permanent paralysis and loss of bowel and bladder control. However, prompt treatment and follow-up care from experienced neurosurgeons can relieve the pressure and restore muscle and nerve functions in the affected areas.
What Is Cauda Equina Syndrome?
The cauda equina is a long bundle of nerve roots at the base of the spine, which provides motor and sensory function in the legs, bladder and bowel. When those nerves are compressed, their ability to execute essential functions such as bowel or bladder control and movement in the legs is compromised. That leads to symptoms such as the following.
- Numbness or weakness in one or both legs
- “Saddle anesthesia” – loss of sensation in the legs, buttocks or inner thighs, areas where a person would sit on a saddle
- Problems with bowel or bladder functioning, either trouble eliminating, or incontinence
- Unexplained sexual dysfunction
- Severe low back pain
If the cause of the pressure is not treated quickly, permanent damage can result, with outcomes including bladder and bowel dysfunction, loss of leg strength and paraplegia.
Causes of Cauda Equina Syndrome
Cauda equina syndrome can be caused by a number of health conditions and events that lead to pressure on the nerves of the cauda equina.
Lumbar Disc Herniation
The most common of these is a massive disc herniation in the spine’s lumbar region. The spinal column contains a series of soft, flexible discs that act as cushions and “shock absorbers” between the bones, and these discs can herniate, or push outward from their original position due to circumstances such as aging and spinal injuries and conditions. When a disc in the lumbar region herniates, it bulges outward and can put pressure on the nerve roots of the cauda equina.
Lumbar Spinal Stenosis
Less often, cauda equina syndrome can also be caused by spinal conditions such as lumbar spinal stenosis, in which the spinal canal becomes narrow and causes pressure on nerves or trauma to the lumbar area.
Spinal Cancer
Cancer can also cause cauda equina syndrome when a tumor in the lumbar area begins to put pressure on the cauda equina.
Infection/Trauma
Infection or inflammation of the spine can also cause swelling and pressure on the nerves, and so can trauma from injury to the lower back in an accident, violent incident, or fall.
Osteoporosis
Rarely, osteoporosis, a degenerative bone disease, can cause fractures in the vertebrae that put pressure on the cauda equina.
Congenital Conditions
Some congenital conditions such as arteriovenous malformations can also create conditions that compress the nerves of the cauda equina.
Regardless of the cause, cauda equina syndrome needs immediate treatment to address the reason for compression of the cauda equina, and restore functioning to the lower body, bowels and bladder.
Diagnosing Cauda Equina Syndrome
It can be difficult to diagnose cauda equina syndrome because symptoms can be vague or intermittent, or they can develop slowly over time. The primary symptoms of cauda equina can also mimic those of other conditions, so it can be misdiagnosed.
Diagnosing cauda equina syndrome begins with a neurological examination that explores symptoms, a patient’s recent history, and the functioning in the affected areas. Because x-rays may not be effective, MRIs or CT scans may be used to reveal soft tissue problems such as herniated discs. A myelogram, in which liquid dye is injected into the spinal column and tracked by imaging technology, can also reveal the source of pressure on the cauda equina.
Treatment Options
When cauda equina syndrome is diagnosed, prompt treatment, ideally within 48 hours, is essential for the best chance of restoring functioning to the lower body, bowels and bladder. But even outside that optimal treatment window, patients can still expect to have improved functioning once the cause of the pressure is removed.
Treating cauda equina syndrome typically requires surgery to remove the cause of pressure on the cauda equina, such as a herniated disc or tumor. Steroids are generally not used to treat cauda equina syndrome, but other types of medications can be used to treat infection and inflammation, and to help people recover after surgery. Whatever the cause of cauda equina syndrome, treatment aims to improve bowel and bladder functioning and to prevent weakness and loss of function in the lower limbs.
Recovering After Cauda Equina Syndrome
Once the cause of cauda equina syndrome is identified and treated, most patients can experience significant improvement, particularly in motor functions of the lower limbs. It can take longer for bowel and bladder function to improve, but follow-up treatment with drug and physical therapies can help to restore as much function as possible. In some cases, patients may need support services and assistive devices for mobility as they recover.
Though it’s relatively rare, cauda equina syndrome can affect people of all ages, and it’s essential to seek medical care when symptoms appear. Experienced neurosurgeons in New Jersey and the tri-state area can develop the best plan for treating cauda equina syndrome – and getting patients back to everyday life.
