Cauda equina syndrome in extruded lumbar disk herniation

Abstract

Cauda equina syndrome (CES) is a rare consequence of lumbar disc prolapse. The reported incidence of CES due to an herniated lumbar disc varies from 1 to 6%. It is defined as a complex of symptoms that include lower back pain, unilateral or more typically bilateral sciatica, saddle sensory disturbances, and variable lower extremity motor and sensory loss, along with bladder, bowel, and erectile dysfunction. The motor loss varies from weakness to flaccid paralysis over time, with no upper motor neuron signs. Similarly, sensory symptoms include saddle anesthesia and a variable sensory loss in lower extremities. Low back pain can be divided into local and radicular pain: local pain is generally a deep aching pain resulting from soft-tissue and vertebral body irritation; radicular pain is generally a sharp, stabbing pain resulting from compression of the dorsal nerve roots and projects in dermatomal distributions. Urinary manifestations of cauda equina syndrome include retention, difficulty initiating micturition, decreased urethral sensation. Typically, urinary manifestations begin with urinary retention and are later followed by an overflow urinary incontinence. Bowel disturbances may include incontinence and/or constipation, and loss of anal tone and sensation.