What are the other Names for this Condition? (Also known as/Synonyms)

• CES (Cauda Equina Syndrome)
• Compression of Spinal Nerve Roots Syndrome
• Spinal Nerve Roots Compression Syndrome

What is Cauda Equina Syndrome? (Definition/Background Information)

• Cauda Equina Syndrome (CES) is a rare, but serious neurological condition characterized by abnormal pressure and swelling of the cauda equina nerves at the end of the spinal cord. It is commonly caused by an injury or a herniated disc in the lower back that compresses the nerve roots
• The signs and symptoms of Cauda Equina Syndrome may include lower back pain, difficulty walking, and urinary retention or incontinence. Some of the complications that may arise can include sensory abnormalities, sexual dysfunction, and the development of urinary bladder stones
• Cauda Equina Syndrome is generally considered a medical emergency that requires immediate surgical treatment. However, the treatment usually depends on the underlying cause of the condition. If diagnosed early and surgical treatment is performed, significant improvement in one’s sensory and motor function is noted
• Currently there are no specific methods or guidelines to prevent Cauda Equina Syndrome. However, protecting the spine from an injury can help decrease the risk of developing the condition

Who gets Cauda Equina Syndrome? (Age and Sex Distribution)

• Cauda Equina Syndrome is a rare condition that typically affects adults
• CES due to trauma can affect individuals of all ages
• No gender, racial, or ethnicity preference is observed

What are the Risk Factors for Cauda Equina Syndrome? (Predisposing Factors)

Common risk factors associated with Cauda Equina Syndrome may include:

• Individuals with a history of spinal conditions (that cause back pain), such as lumbar spinal stenosis
• Individuals with a history of spinal surgery
• Degenerative joint disease (osteoarthritis)
• Spina bifida: A serious medical disorder in which the backbones do not close (form) around the spinal cord, before birth
• Hemorrhages affecting the spinal cord
• Spinal arteriovenous malformations
• Infection of the spine
• Coagulopathy (easy bleeding), which is a bleeding disorder that decreases the body’s ability to form blood clots (or coagulates)
• In rare cases, spinal manipulation of the lower back
• Lesion or tumor affecting the spinal bones, spinal nerve roots, or cerebrospinal fluid (CSF)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cauda Equina Syndrome? (Etiology)

Common causes associated with Cauda Equina Syndrome include the following:

• Sports injury or direct trauma to the lumbar spine, associated with a gunshot or knife wound, car accident, fall, or surgery
• Certain spinal conditions that may compress the nerves in the lower back, such as a herniated disc in the lower back, or lumbar spinal stenosis
• Ankylosing spondylitis: An inflammatory disorder that causes chronic inflammation in the spine and sacroiliac joint (a pelvic joint)
• Spinal epidural abscess (infection around the spinal cord)
• Spinal tumors

What are the Signs and Symptoms of Cauda Equina Syndrome?

The signs and symptoms of Cauda Equina Syndrome can resemble other medical conditions. The onset of the signs and symptoms may occur suddenly or slowly, developing over time. The severity of the condition depends on the amount of compression and the specific nerve roots that are being compressed. The signs and symptoms of Cauda Equina Syndrome include:

• Pain in the lower back
• Difficulty walking due to progressive weakness or numbness in the legs and feet
• Urinary retention or difficulty holding urine in the bladder (urinary incontinence)
• Numbness or tingling sensation in the buttocks or lower extremities
• Saddle anesthesia: Loss of sensation to the buttocks and perineum (the region between the anus and genitals)
• In some cases, sexual dysfunction with impotence (erectile dysfunction) may occur

The signs and symptoms of Cauda Equina Syndrome (CES) usually vary in intensity and onset:

• Sudden onset CES: The symptoms of sudden onset are usually evident by urinary incontinence or dysfunction and progressive weakness in the legs and/or feet
• Gradual onset CES: The symptoms of gradual onset usually include recurring back pain associated with muscle weakness and numbness, and urinary incontinence or dysfunction

Individuals with any of the above signs and symptoms of Cauda Equina Syndrome should seek immediate medical attention.

How is Cauda Equina Syndrome Diagnosed?

Diagnostic tools that aid in identifying the exact cause of Cauda Equina Syndrome include:

• Complete physical examination of the back with evaluation of medical history
• Spinal X-ray: X-rays of the spine are useful in ruling out other possible causes that have related symptoms
• Computerized tomography (CT) scan of the affected region: A CT scan takes a series of X-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues in the body. This allows a healthcare provider to examine the spinal column and surrounding structures
• Magnetic resonance imaging (MRI) scan of the spine: An MRI is a more detailed scan that produces three-dimensional images of body structures using a magnetic field and computer technology to generate images of interior bones and soft tissue. This can help confirm a diagnosis
• Bone scan: A bone scan is a diagnostic method used to identify any bone abnormalities. It is undertaken by injecting small amounts of radioactive material into the bloodstream. This may be performed to help determine the underlying cause of the condition
• CT myelogram: It is a specialized diagnostic imaging procedure in which a special dye is injected into the surrounding areas of the spinal cord. X-rays or CT scan images are then taken to help a healthcare provider detect any spinal abnormalities
• Blood cultures to rule out an infection

Note: Differential diagnoses, to eliminate other conditions are often considered, before arriving at a definitive diagnosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cauda Equina Syndrome?

The complications associated with Cauda Equina Syndrome may include:

• Prolonged and chronic pain in the back
• Permanent sensory abnormalities
• Permanent urinary incontinence
• Permanent bladder, bowel, and sexual dysfunction
• Formation of urinary bladder stones (bladder calculi)
• Kidney infection

How is Cauda Equina Syndrome Treated?

• The medical treatment for Cauda Equina Syndrome depends on the underlying cause of the condition
• Non-steroidal anti-inflammatory oral medications, such as ibuprofen, may be used to decrease any pain and swelling

In many cases, Cauda Equina Syndrome is considered a medical emergency and usually requires immediate surgical treatment. The treatment methods that may be performed include the following:

• Microlumbar discectomy (MLD): MLD is an advanced, minimally-invasive surgical procedure for the lumbar region. It uses a specialized surgical instrument with an attached microscope to inspect the problem region. During the procedure, the part of the herniated disc that is damaged and any bone fragments (causing abnormal pressure on the spinal nerves), are removed
• Lumbar laminectomy: It is a surgical procedure intended to relieve pressure on the spinal cord and nerves by removing the lamina to widen the spinal cord. During a lumbar laminectomy procedure, the lamina (the small section of the bony roof in the spine) is removed to create additional space for the surrounding nerves within the spinal canal. A bone graft material then fills the empty space, and two or more vertebrae of the lumbar spine are fused together to create stability. However, this procedure may also be performed without a lumbar spinal fusion, or the healthcare provider may elect to perform a microlumbar discectomy (removing a part of the lumbar disc).

How can Cauda Equina Syndrome be Prevented?

Currently, there are no specific methods or guidelines to prevent Cauda Equina Syndrome. Nevertheless, the following may be considered:

• Protecting the spine from a spinal injury can decrease the risk for developing the condition
• Individuals who participate in any high-impact sports, such as football, should wear appropriate safety equipment to help decrease the risk of sustaining an injury or developing a herniated disc in the lower back region, which is a common cause of Cauda Equina Syndrome
• Undertaking prompt and adequate treatment of any condition (such as tumor, infection, or joint disorder) that affects the spine

What is the Prognosis of Cauda Equina Syndrome? (Outcomes/Resolutions)

The prognosis of Cauda Equina Syndrome depends on an early diagnosis and adequate surgical treatment.

• Individuals may experience significant improvement in sensory and motor deficit and urinary function 48 hours after a lumbar laminectomy surgical procedure
• If the diagnosis of Cauda Equina Syndrome is delayed or if the condition is left untreated, it can result in permanent paralysis and urinary incontinence
• It is very difficult to diagnose CES; in many cases, an accurate diagnosis is often delayed. If diagnosed and treated early, it may help prevent complications from developing in the future

Additional and Relevant Useful Information for Cauda Equina Syndrome:

Cauda Equina Syndrome is a rare but serious condition that gets its name from the Latin term "horse’s tail”. This is because the nerves at the end of the spine resemble a horse’s tail as they extend from the spinal cord down the back of both legs.