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Vega-Arroyo Miguel, MD, Section of Neurosurgery, Department of Surgery, University of Manitoba.
Perry Dhaliwal, MD, MPH, FRCSC, Assistant Professor of Neurosurgery, Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba.
Abstract
Cauda equina syndrome (CES) is the collection of signs and symptoms produced by severe compression of the lumbar spinal nerves that form the cauda equina. The compression can be caused by lumbar degenerative changes, intraspinal tumors, epidural hematoma, and infections. Rapid diagnosis and treatment are paramount as CES requires emergent surgical decompression. With delay, the patient could develop permanent neurological deficits including loss of lower limb sensorimotor function, bladder, bowel, and/or sexual dysfunction. Unfortunately, even with expeditious surgery, neurological improvements remain unpredictable. Failure to fully explain the possible prognoses can involve all the healthcare providers in medicolegal consequences.
Key Words: Cauda Equina Syndrome, Spine Emergency, Urinary retention, MRI scanning, Saddle Anesthesia.
Introduction and Background
Cauda Equina Syndrome (CES) is a devastating spine surgical emergency with potentially significant neurologic morbidity, including bladder, bowel, and sexual dysfunction, leg numbness, weakness, and radicular pain.1-4 CES is caused by a large space-occupying lesion within the central canal of the lumbosacral spine. It is the most common non-traumatic spinal surgical emergency with high morbidity that can lead to irreversible neurological sequelae when misdiagnosed and/or treatment is delayed beyond 48 hours of its clinical establishment.4
What is the Cauda Equina?
Definition of Cauda Equina Syndrome
The term Cauda Equina was coined by the French anatomist Andreas Lazarius (1558-1609) while describing "rope-like" fibers at the end of the spinal cord and its resemblance to a horse's tail (from Latin: Cauda—tail, and Equinus—horse)5 (Figure 1). Hence, "Cauda Equina" only refers to the collection of the lower lumbar, sacral, and coccygeal nerves distal to the conus medullaris. "Cauda Equina Syndrome" is the acute clinical syndrome of lower back pain, sensory loss and motor weakness in the lower extremities, saddle anesthesia, and bowel / bladder dysfunction (the last two are required to establish the diagnosis of CES).4,6