Cauda Equina Syndrome - Symptoms, causes and treatment

Cauda equina syndrome is a condition when the group of nerve roots (cauda equina) at the bottom of the spinal cord is compressed. Nerve roots act as a link between the brain and lower body organs, in sending and receiving sensory and motor signals, to and from the legs, feet, and pelvic organs. When a nerve root is compressed, the signal is cut off and affects the function of certain body parts.

Cauda equina syndrome is a rare medical condition. If people with cauda equina syndrome are not treated promptly, this condition can lead to permanent paralysis, urinary and stool incontinence, and sexual dysfunction. Sometimes, emergency treatment is still unable to restore the patient's overall body function.

Causes of Cauda Equina Syndrome

Cauda equina syndrome is caused by a variety of conditions that result in inflammation or pinching of the nerves at the bottom of the spine. One of the conditions that cause cauda equina syndrome is a herniated disc or herniated nucleus pulposus. Disc herniation is a condition when the spinal discs shift. In addition, there are several conditions that can also cause cauda equina syndrome, namely:

  • Infection or inflammation of the spine
  • Spinal stenosis
  • Lower spine injury
  • Birth defects
  • arteriovenous malformations
  • Tumors in the spine
  • Spinal bleeding (subarachnoid, subdural, epidural)
  • Complications after spinal surgery.

In addition, there are several factors that increase a person's risk of developing cauda equina syndrome, namely:

  • seniors
  • Athlete
  • Being overweight or obese
  • Often lifts or pushes heavy objects
  • Back injury from a fall or accident.

Symptoms of Cauda Equina Syndrome

Symptoms of cauda equina syndrome are variable, develop gradually, and sometimes resemble the symptoms of other diseases, making it difficult to diagnose. Symptoms that can appear include:

  • Severe pain in the lower back
  • Pain along the pelvic nerve (sciatica), either in one or both legs
  • Numbness in the groin area
  • Disturbances in defecation and urination
  • Reduced or lost lower limb reflexes
  • Leg muscles weaken.

Diagnosis of Cauda Equina Syndrome

Doctors can suspect a patient has cauda equina syndrome if there are symptoms, which are confirmed by a physical examination. During the physical exam, the doctor will test the patient's balance, strength, coordination, and reflexes in the legs and feet. The doctor will instruct the patient to:

  • Sit down
  • Stand up
  • Walk on heels and toes
  • Lifting the legs in a lying position
  • Bend forward, backward, and sideways.

Imaging tests are also performed to confirm the patient's diagnosis. Among others are:

  • myelography, is a spinal examination procedure using X-rays and a contrast fluid is injected into the tissue around the spine. This examination can show the pressure that occurs on the spinal cord.
  • CT scan, to produce images of the condition of the spinal cord and surrounding tissues from various angles.
  • MRI, to produce detailed images of the spinal cord, nerve roots, and the area around the spine.
  • electromyography, to evaluate and record the electrical activity produced by muscles and nerve cells. Electromyography results can see impaired nerve and muscle function.

Cauda Equina Syndrome Treatment

After the doctor confirms that the patient is diagnosed with cauda equina syndrome, emergency treatment through surgery needs to be done immediately. Surgery aims to relieve pressure on the spinal nerve endings. If cauda equina syndrome is caused by a herniated disc, surgery may be performed on the spinal column to remove the material pressing on the nerve.

Surgery should be performed within 24 or 48 hours of the onset of symptoms. This action aims to prevent nerve damage and permanent disability.

Postoperative treatment will be carried out on patients after undergoing surgery. Some of the treatments carried out are:

  • Drug therapy. The doctor will give several types of drugs to control or prevent other conditions that the patient may experience postoperatively. Among others are:
    • Corticosteroids, to relieve postoperative inflammation
    • Pain relievers, such as paracetamol, ibuprofen, to oxycodone, to relieve postoperative pain
    • Antibiotics, if cauda equina syndrome is caused by infection
    • Medicines to control bladder and bowel function, such as tolterodine or hyoscyamine.
  • radiotherapy or chemotherapy, as a postoperative follow-up treatment if the cauda equina syndrome is caused by a spinal tumor.
  • Physiotherapy.If cauda equina syndrome affects the ability to walk, the doctor will recommend the patient to undergo physiotherapy. Medical rehabilitation doctors will plan a therapy program, which can help patients to restore leg strength to walk.

Surgery does not directly restore the function of the body as a whole. This condition depends on the level of nerve damage experienced by the patient. Bladder and bowel function can take several years to return to normal.

Cauda Equina Syndrome Prevention

Prevention of cauda equina syndrome is difficult, because the appearance of this syndrome often results from unpredictable injury or trauma. However, cauda equina syndrome caused by infection can be triggered by injecting drug abuse. Therefore, the preventive measure that can be taken is not to use illegal injecting narcotics.

Complications of Cauda Equina Syndrome

If not treated immediately, cauda equina syndrome can cause several complications, namely:

  • Permanent paralysis. A compressed nerve can be permanently damaged if left untreated, resulting in permanent paralysis, especially in the limbs.
  • Urinary and stool incontinence, occurs when the body loses control of urination (urinary incontinence), or bowel movements (fecal incontinence). This condition is caused by nerves that do not function normally.
  • Sexual dysfunction. Cauda equina syndrome can also cause impaired nerve function in the reproductive organs, especially men.