Cauda equine syndrome is an extreme version of nerve compression or inflammation of the nerve roots in the lower portion of the spinal canal. Cauda equina syndrome can cause symptoms of pain, altered reflexes, decreased strength, and decreased sensation. It is considered a surgical emergency because if left untreated it can lead to permanent loss of bowel and bladder control and paralysis of the legs.
Symptoms of cauda equina syndrome include:
- Lower back pain, generally a deep, aching pain.
- Leg pain (radicular pain), generally a sharp, stabbing pain that results from nerve root compression.
- Lower extremity muscle weakness and loss of sensations.
- Reduced or absent lower extremity reflexes.
- Sciatica: pain in one leg (unilateral) or both legs (bilateral) that starts in the buttocks and travels down the back of the thighs and legs.
- Perineal numbness in the groin area.
- Bladder/urinary disturbances including inability to urinate (urinary retention), difficulty urinating (urinary hesitancy), decreased urinary sensation, and inability to control urination (incontinence).
- Bowel disturbances including inability to stop or feel a bowel movement (incontinence), constipation, or loss of anal sensation.
Cauda equina syndrome is caused when the nerve roots below the level of the spinal cord are severely compressed by narrowing of the spinal canal. Causes may include:
- traumatic injury
- spinal disk herniation
- spinal stenosis (narrowing of the diameter of the spinal canal) either due to developmental abnormality or normal degenerative process
- spinal tumors (neoplasms)
- inflammatory conditions of the spine, including Paget disease and ankylosing spondylitis
- infections in the spinal canal (spinal epidural abscess)
Diagnosis of cauda equina is usually confirmed by an MRI scan or CT scan. If cauda equina syndrome exists, surgery is often required. Sudden onset of cauda equina syndrome is a medical emergency requiring surgery to avoid long-term neurological damage.
Some complications of Cauda equina may also be considered symptoms. Complications may include radiculopathy, back pain, urine incontinence,
or fecal incontinence.
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