Cauda Equina Syndrome is not treated by Chiropractors. It is our intent to provide the following information below on this rare disorder that usually is a surgical emergency!
Low back pain is very common. It affects millions of people. In most cases, you don't need surgery for low back pain. But in rare cases, severe back pain can be a sign of cauda equina syndrome (CES), a condition that usually requires urgent surgical treatment. People with cauda equina syndrome often are admitted to a hospital as a medical emergency. Here's what you need to know about cauda equina syndrome.
What Is Cauda Equina Syndrome (CES)?
In patients with cauda equina syndrome, something compresses on the spinal nerve roots. You may need fast treatment to prevent lasting damage leading to incontinence and possibly permanent paralysis of the legs.
CES affects a bundle of nerve roots called cauda equina (Latin for horse's tail). These nerves are located at the lower end of the spinal cord in the lumbar spine. They send and receive messages to and from your legs, feet, and pelvic organs.
Causes of Cauda Equina Syndrome
CES occurs more often in adults than in children. But it can occur in children who have a spinal birth defect or have had a spinal injury.
These are the most common causes of cauda equina syndrome:
- A severe ruptured disk in the lumbar area (the most common cause).
- Narrowing of the spinal canal (stenosis).
- A spinal lesion or tumor.
- A spinal infection, inflammation, hemorrhage, or fracture.
- A complication from a severe lumbar spine injury such as a car crash, fall, gunshot, or stabbing.
- A birth defect such as an abnormal connection between blood vessels (arteriovenous malformation).
Symptoms of Cauda Equina Syndrome
It may be hard to diagnose cauda equina syndrome. Symptoms vary and may come on slowly. They also mimic other conditions.
Physicians need to be aware of certain "red flags" that indicate cauda equina syndrome. Red flags in someone with back pain include saddle anesthesia, recent onset of bladder dysfunction (such as urinary retention or incontinence), bowel incontinence and motor weakness in the lower extremity. The presence of these symptoms warn of cauda equina compression.
Red flags also may be present in a patient?s history. Recent trauma, a history of cancer or a severe infection may predispose a person to cauda equina syndrome. Any of these diseases can involve the discs or the bones of the lumbar spine and result in cauda equina syndrome. Other conditions that may rarely lead to cauda equina syndrome include osteoporotic vertebral fractures and spinal stenosis.
Besides the classic red flag symptoms, physicians suspecting the syndrome look for reflex abnormalities such as the loss or diminution of reflexes, sensory abnormality in the legs, bladder or rectum, and muscle weakness or wasting in the legs.
If you have any of these symptoms, see your doctor right away:
- Severe low back pain.
- Pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair.
- Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet that is severe or gets worse and worse. You may experience this as trouble feeling anything in the areas of your body that would sit in a saddle (called saddle anesthesia).
- Recent problem with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it (incontinence).
- Sexual dysfunction that has come on suddenly.
Diagnosing Cauda Equina Syndrome
A physiician can diagnose cauda equina syndrome. Here's what you may need to confirm a diagnosis:
- A medical history, in which you answer questions about your health, symptoms, and activity.
- A physical exam to assess your strength, reflexes, sensation, stability, alignment, and motion. You may also need blood tests. Magnetic resonance imaging (MRI) scan, which uses magnetic fields and computers to produce three-dimensional images of your spine.
- A myelogram -- an X-ray of the spinal canal after injection of contrast material -- which can pinpoint pressure on the spinal cord or nerves.
- A computed tomography (CT) scan.
Treating Cauda Equina Syndrome
If you have cauda equina syndrome, you are probably wondering about treatment, recovery, and the long-term outcome (prognosis).
You'll need prompt "EMERGENCY" treatment to relieve pressure on nerves. Surgery must be done quickly to prevent permanent damage, such as paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems. It is best if this occurs within 24-48 hours of the onset of symptoms which gives maximum potential for improvement of sensory and motor deficits as well as bladder and bowel functioning. Most surgeons recommend surgery to decompress the nerves as soon as possible, within about 8 hours of onset of symptoms.
Depending on the cause of your CES, you may also need high doses of corticosteroids. These can reduce swelling. If you are diagnosed with an infection you may need antibiotics.
Even with treatment, you may not retrieve full function.The prognosis for cauda equina syndrome depends on a variety of factors, including the degree of nerve damage and how quickly the nerve is decompressed. Patients should be aware that acute cauda equina syndrome that results in nerve damage is extremely rare. Following surgery, the extent of the recovery is variable, and patients may continue to have some pain, problems with their bladder or bowel, and other dysfunctions depending on the duration and severity of symptoms prior to surgery. If surgery is successful, you may continue to recover bladder and bowel function over a period of years.
Living With Cauda Equina Syndrome
If permanent damage has occurred, surgery cannot always repair it. Your cauda equina syndrome is chronic. You will need to learn ways to adapt to changes in your body's functioning. You'll find that both physical and emotional support is essential.
Try to involve your family in your care. Many professionals can also provide you support. Depending on your limitations, you can seek help from:
- An occupational or physical therapist
- A social worker
- A continence advisor
- A sex therapist
And, as with many conditions, there may be nothing quite as helpful as support from those who really understand what you're going through. That's why joining a cauda equina support group may be a good idea.
If you have loss of bladder or bowel function, the following tips may help:
- Use a catheter to completely empty your bladder three or four times a day.
- Drink plenty of fluids and use good personal hygiene to prevent urinary tract infections.
- Check for waste and clear the bowels with gloved hands. If needed, use glycerin suppositories or enemas.
- Wear protective pads and pants to prevent leaks.
Also, ask your physician about medication for help with pain, as well as bladder and bowel problems.