Cauda equina syndromes in conservative care: four case reports

Abstract

The clinical picture of “full-blown” cauda-equina syndrome is well documented. It is considered a neurological emergency, as prompt decompressive surgery has been show to enhance recovery and reduce the occurrence of disability and dysfunction. However, cauda equina syndrome can be easily overlooked in its early stages when its clinical picture is less distinct. The evidence for appropriate management of early cauda equina syndrome is sparse compared with that for the full-blown syndrome. The syndrome may occur as a rare complication of lumbar intervertebral disc herniation and will therefore be encountered occasionally in chiropractic practice. Although it is extremely rare for I to be associated with spinal manipulation, the risk of temporal association is increased if the clinician fails to recognise the syndrome in its early stages. This paper presents four cases of patients who presented to chiropractors in the UK with symptoms of cauda equina syndrome. These cases illustrate acute and chronic cauda equina syndrome as well as its early and full-blown clinical pictures. The aetiology of cauda-equina syndrome and its identification and management in a chiropractic setting are also discussed.