Cauda equina syndrome

Cauda equina syndrome
The cauda equina is the "horse tail" of nerves that branch off after the conus medullaris
SpecialtyNeurosurgery, orthopedics
SymptomsLow back pain, pain that radiates down the leg, numbness around the anus, loss of bowel or bladder control[1]
Usual onsetRapid or gradual[1]
CausesDisc herniation, spinal stenosis, cancer, trauma, epidural abscess, epidural hematoma[1][2]
Diagnostic methodMedical imaging (MRI, CT scan)[1][3]
TreatmentSurgery (laminectomy)[1]
Prognosis20% risk of poor outcome
Frequency1 in 500,000 a year

Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged.[2] Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control.[1] Onset may be rapid or gradual.[1]

The cause is usually a disc herniation in the lower region of the back.[1] Other causes include spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma.[1][2] The diagnosis is suspected based on symptoms and confirmed by medical imaging such as MRI or CT scan.[1][3]

CES is generally treated surgically via laminectomy.[1] Sudden onset is regarded as a medical emergency requiring prompt surgical decompression, with delay causing permanent loss of function.[4] Permanent bladder problems, sexual dysfunction or numbness may occur despite surgery.[1][3] A poor outcome occurs in about 20% of people despite treatment.[1] About 1 in 70,000 people is affected every year.[1] It was first described in 1934.[5]

  1. ^ a b c d e f g h i j k l m n Gardner A, Gardner E, Morley T (May 2011). "Cauda equina syndrome: a review of the current clinical and medico-legal position". European Spine Journal. 20 (5): 690–7. doi:10.1007/s00586-010-1668-3. PMC 3082683. PMID 21193933.
  2. ^ a b c "Cauda equina syndrome". Genetic and Rare Diseases Information Center (GARD). 2015. Retrieved 9 November 2017.
  3. ^ a b c "Cauda Equina Syndrome-OrthoInfo – AAOS". orthoinfo.aaos.org. March 2014. Retrieved 9 November 2017.
  4. ^ Cite error: The named reference :1 was invoked but never defined (see the help page).
  5. ^ Chau AM, Xu LL, Pelzer NR, Gragnaniello C (2014). "Timing of surgical intervention in cauda equina syndrome: a systematic critical review". World Neurosurgery. 81 (3–4): 640–50. doi:10.1016/j.wneu.2013.11.007. PMID 24240024.