In a quandary about cauda equina syndrome?

Abstract

A: The term cauda equina can be literally translated as "the horse's tail." A bundle of nerve roots that constitutes the cauda equina begins below the level of the spinal cord termination, usually between the first and second lumbar vertebra. CES is rare, occurs equally in men and women, and isn't age specific. Occurring traumatically or atraumatically, CES may result from any lesion that compresses the cauda equina nerve roots, which can occur from inflammation, direct compression, ischemia, or venous congestion. The most common cause is lumbar intervertebral disk herniation. Other causes include traumatic injury, abscess, spinal anesthesia, tumor ankylosing spondylitis, inferior vena cava thrombosis, lymphoma, and sarcoidosis. The nerve roots of the cauda equina are susceptible to injury and increased permeability, which may then lead to edema formation even with the slightest injury.Figure: Q:I just received a post-op laminectomy patient with cauda equina syndrome (CES). What is it?CES has no definite criteria for diagnosis. Diagnosis includes your patient's clinical history, physical exam, and radiologic testing. The patient usually presents with low back pain that's different than common lumbar strain, unilateral or bilateral lower extremity motor or sensory abnormality, recent onset of bladder dysfunction (such as bladder incontinence or retention), bowel incontinence, perineal anesthesia, pain in the legs or radiation to the legs, reflex abnormalities (loss or diminished), pain localized to the low back, and poor sphincter tone. To prevent and avoid lifelong disability, a careful examination and history taking is crucial. Imaging studies that are useful in identifying CES are computed tomography scan, magnetic resonance imaging, and computed tomography myelography. Catheterization for residual urine volume may reveal urinary retention, which suggests a neurogenic bladder. Patients who have suspected CES are referred immediately for a neurologic evaluation. After CES is diagnosed, surgical intervention may be indicated if compression is due to disk herniation. Usually, surgical decompression is recommended within 24 to 48 hours of symptom onset to avoid permanent neurologic damage. Complications your patient may experience include residual weakness, incontinence, impotence, and sensory abnormalities. You can help your patient travel the road of recovery by offering appropriate education regarding CES, referring him to support groups, and allowing him and his family to voice their concerns about this potentially life-altering condition.