Cauda Equina Syndrome

What is Cauda Equina Syndrome?

Cauda Equina Syndrome (CES) is a rare but serious medical condition that occurs when the nerve roots in the lumbar spine, known as the cauda equina, are compressed. This bundle of nerves, located at the end of the spinal cord, looks like a horse’s tail and provides crucial motor and sensory functions to the legs and bladder. If the nerves don’t work properly – a patient can experience numbness and bladder or bowel dysfunction. Cauda Equina Syndrome requires urgent medical care to prevent further damage, including permanent paralysis or permanent loss of bowel or bladder function. The sooner a doctor treats the condition, the better the chance of a favorable outcome. Doctor Andre M. Samuel, orthopedic spine specialist, treats patients in the Clear Lake, Houston, Sugar Land, TX area who have Cauda Equina Syndrome or similar bowel and bladder incontinence problems.

What are the common causes of Cauda Equina Syndrome?

A large, herniated disc in the lumbar region is the most common reason a patient suffers from cauda equina syndrome. It can also be caused by a narrowing spinal canal  due to arthritis, spinal lesions, tumors, and infections. Violent injuries to the lower back,  such as falls and auto accidents, may also lead to CES. Children with birth defects such as spina bifida also have a greater chance of developing the syndrome, which tends to be more common in females between 30 and 49 years of age.

What are the first signs or symptoms of Cauda Equina Syndrome? 

The intensity of symptoms of Cauda Equina Syndrome can vary, depending on how much pressure is on the nerve roots. Not being able to urinate is the most common symptom, which can lead to urinary and fecal incontinence. Other symptoms include loss of sensation in the buttocks, genitals, and anus. Some patients also experience difficulty moving the lower limbs, sciatica-like pain in the back and legs, and sexual dysfunction. If you are experiencing any of these symptoms, seek medical attention immediately to determine if you have CES.

How is Cauda Equina Syndrome diagnosed?

Dr. Samuel takes an extensive medical history and conducts a thorough physical examination on every patient. The exam may include an SLR test, where the patient lies down and Dr. Samuel slowly raises the patient’s leg, keeping the knee straight. Pain that radiates down your leg while in this position can indicate pressure on the nerve roots, indicating a possible cauda equina syndrome diagnosis.  An MRI, CT Scan, or X-rays may also help see inside the spinal canal to determine if there are any tumors, lesions, or spinal stenosis.

What is the treatment for Cauda Equina Syndrome?

Non-surgical treatment:

Non-surgical treatments to manage the symptoms of Cauda Equina Syndrome (CES) include:

• Corticosteroids to reduce inflammation
• NSAIDs or Opioids to manage pain
• Intermittent catheterization for urinary retention
• Medications to address urinary and bowel dysfunction
• Activity adjustments to avoid symptom aggravation

Surgical treatment:

While non-surgical treatments can manage some symptoms of CES, they do not provide a definitive cure and are not the sole approach for someone with a confirmed diagnosis. Decompression surgery is often needed to prevent irreversible nerve damage, permanent paralysis, and loss of bladder and bowel control. Other surgeries may include:

• Laminectomy – Part of the vertebral bone is removed.
• Discectomy – All or part of the herniated disc is removed.
• Foraminotomy – Enlargement of the opening where nerve roots exit the spine.

Dr. Samuel works closely with each patient to decide between surgical and non-surgical treatment. Sometimes, emergency surgery is needed to prevent further damage. Decisions are made on a case-by-case basis taking into account symptoms, the cause of the cauda equina syndrome, and the patient’s overall health.

Is Cauda Equina Syndrome reversible?

Cauda Equina Syndrome (CES) is treatable, but the extent of recovery varies from patient to patient. Prompt detection and intervention are critical for the best outcomes. Post-surgery, patients typically experience different levels of improvement, but some may continue to face chronic symptoms requiring ongoing care. Patients who still have urinary challenges will learn to master self-catheterization. A comprehensive bowel regimen, incorporating dietary changes, routine toileting, and possibly medication, can also address constipation or incontinence. Collaborating closely with Dr. Samuel and his team is essential to develop a long-term individualized care plan.