Millions of people are affected by lower back pain worldwide. Usually, back pain can be treated easily and does not have a serious underlying cause.
But in rare cases, severe back pain can be due to a condition known as the “cauda equina syndrome” or CES, a condition that is oftentimes misdiagnosed.
What is Cauda Equina Syndrome?
This syndrome occurs when the nerve roots of the cauda equina are compressed. Cauda equina (Latin for a horse’s tail) is the lowermost area of the spinal cord, shaped like the tail of a horse, from where various nerve roots branch out.
The spinal cord ends at the upper portion of the lumbar spine. Due to pressure on the lower nerve roots, motor and sensory functions may be disrupted as these nerve roots supply the lower extremities and the bladder.
Cauda equina syndrome is a rare condition but has serious consequences if not promptly treated. Unlike most back problems which are chronic, CES in an acute condition and occurs suddenly, like a heart attack. It may also come on gradually in some people, which is less common, but still possible.
What are the causes of CES?
Some of the main causes of this condition include:
- Ruptured or herniated discs in the lumbar area
- Complications from a severe injury involving the spine, such as a road traffic accident, gunshot, or severe sports injury
- Spinal stenosis (narrowing of the spinal canal). If lumbar stenosis puts pressure on the spinal canal, it may result in cauda equina syndrome or pinch the sciatic nerve in the lower back, resulting in sciatica
- A spinal infection, inflammation or a fracture
- A spinal lesion or malignancy
- Birth defects and abnormalities
- Post-operative lumbar spinal surgery complications
- Spinal cord compression
Signs and Symptoms
Symptoms of cauda equina syndrome include:
- Low back pain that is severe.
- Numbness or weakness in one or both legs.
- Sensory loss or pain in one or both legs.
- Loss of reflexes in extremities.
- Loss or altered sensations in the legs, buttocks, inner thighs, back of the legs or feet. It is also known as saddle anaesthesia (loss of ability to feel anything in the areas of the body that sit on a saddle).
- Loss of bladder control (urinary retention or incontinence) or bowel control.
- Sexual dysfunction that comes on suddenly.
As previously stated, in CES these symptoms tend to appear suddenly, rather than on a gradual basis.
Tests and Diagnosis
To diagnose cauda equina syndrome, a doctor will start by asking about your medical history as well as performing a physical examination. He/she may then advise an MRI (magnetic resonance imaging) or a myelogram to confirm the diagnosis and to help provide appropriate medical advice. An MRI is usually done, as it is the best method to visualize the spinal cord, nerve roots, discs and ligaments.
Treating Cauda Equina Syndrome
CES represents a medical emergency, and the aim of the treatment here will be to relieve the pressure on the nerves. Emergency surgery is usually done or is planned quickly. This is necessary to prevent any complications or permanent damage, such as nerve damage, urinary tract infections, or sexual dysfunction. In more severe cases, it may lead to loss of bladder and bowel function and even result in permanent paralysis of the legs.
Further treatment options will depend on the cause. For example, if your symptoms are due to an infection, antibiotics will be prescribed, or medicines will be prescribed to reduce inflammation if it is present, along with the surgery.
If the surgery is successful, you will be able to recover completely. Recover depends on the damage that has already occurred. However, recovering from bladder and bowel control may take longer.
Post-surgery, you will have to make some lifestyle changes. You might have to opt for physiotherapy, or occupational therapy due to dysfunction of the lower limbs if it is present. Weight loss is also advised for overweight people.
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The only way to prevent Cauda Equina Syndrome is early detection and prompt treatment. Early diagnosis can be made by identifying signs as soon as possible, which include noticing any changes in bowel and bladder function, or loss of feeling in the groin. Sensory changes may begin as pins and needles, or numbness.
Coping with Cauda Equina Syndrome
CES, if chronic, can affect people physically as well as emotionally. It may be difficult for people to work after being diagnosed, which may be due to severe pain, motor or sensory weakness, or incontinence problems which make everyday life to be highly difficult.
Pain medications may be used to reduce the pain, and at the same time it is essential that patients with cauda equina syndrome receive emotional support from family and friends.
It is also necessary to work closely with a healthcare professional so that all the problems are addressed and properly managed. Physical therapy and counselling can help the patients a lot to cope with CES.
Author: Spinal Backrack