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 equine syndrome” or CES. This is not well known and is often misdiagnosed. People with the cauda equine syndrome usually come to the hospital and are admitted as a medical emergency. This post will tell you what you need to know about this condition.
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 a tail of the horse, from where various nerve roots branch out from the spine. The spinal cord ends at the upper portion of the lumbar spine. Due to pressure on the lower nerve roots, motor and sensory functions are disrupted. 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 rapidly, like a heart attack. It may also come on gradually in some people, which is less common as compared to the short-term progression.
What are the causes of CES?
- Ruptured or herniated disc in the lumbar area
- Complication from a severe injury involving the spine, like a road traffic accident, gunshot, 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
- A spinal infection, inflammation or a fracture
- A spinal lesion or malignancy
- Birth defects and abnormalities
- Post-operative lumbar spinal surgery complications
Signs and Symptoms
The cauda equina syndrome has a range of symptoms, which may vary in intensity. The symptoms depend on the degree of compression and the nerve roots involved. There are a number of other conditions which result in similar symptoms as those in the CES, so its diagnosis is somewhat difficult.
The following signs and symptoms occur in the cauda equina syndrome:
- Low back pain that is severe.
- Numbness or weakness in the legs, can be one or both.
- Sensory loss or pain in one or both legs.
- Loss of reflexes in extremities.
- Loss of altered sensations in the legs, buttocks, inner thighs, back of the legs or feet. It is also known as saddle anesthesia (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.
Tests and Diagnosis
Cauda equina syndrome is difficult to diagnose as it is a rare condition, and its symptoms are similar to the symptoms of other conditions. The symptoms also vary in intensity. A doctor will start by asking about your medical history as well as performing a physical exam. He will then advise an MRI (magnetic resonance imaging) or a myelogram to confirm the diagnosis. 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
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 paralysis of the legs, loss of bladder and bowel function or sexual dysfunction.
Further treatment 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. 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. You will also need to lose weight if you are obese.
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 are socially unacceptable. It can be very distressing for people to cope with CES apart from having a negative impact on social life, work and relationships.
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. Also, it is necessary to work closely with the 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.