Cauda equina syndrome

Approximate area of "saddle anesthesia" seen from behind (yellow highlight)

Cauda equina syndrome (CES) is a serious neurologic condition that arises due to the damage of the cauda equina, a collection of spinal nerves and nerve roots at the lower end of the spinal cord. The syndrome presents with a range of symptoms including low back pain, leg pain, numbness around the anus, and loss of bowel or bladder control. The onset of symptoms can either be rapid or gradual.

Causes and Diagnosis

CES most commonly results from a disc herniation in the lower region of the back. Additional causes include spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma. Diagnosis of CES is typically suspected based on patient symptoms and further confirmed via medical imaging techniques such as MRI or CT scan.

Treatment and Prognosis

The primary treatment for CES involves surgical intervention, typically through a procedure known as laminectomy. However, despite surgical intervention, there may be persistent issues such as permanent bladder complications, sexual dysfunction, or numbness. Unfortunately, approximately 20% of individuals experiencing CES may have a poor outcome, even with treatment. The annual incidence of CES is roughly 1 in 70,000 people. The condition was first described in the medical literature in 1934.

Clinical Manifestations

Clinical symptoms of CES often include severe low back pain, along with the characteristic symptom of saddle anesthesia. This is a specific form of anesthesia or paraesthesia affecting the S3 to S5 dermatomes, including areas such as the perineum, external genitalia, and anus. To put it in simpler terms, patients often describe a feeling of numbness or "pins-and-needles" sensations in the areas of the groin and inner thighs that would contact a saddle when riding a horse.

Summary

Cauda Equina Syndrome represents a serious neurological condition requiring prompt diagnosis and treatment. Despite advancements in medical and surgical care, there may be significant and permanent sequelae in a subset of patients. A high index of suspicion and appropriate diagnostic evaluations are paramount in managing this condition to mitigate the potential for poor outcomes.

See Also

• Lumbar Disc Disease
• Spinal Stenosis
• Epidural Abscess

References

Cauda equina syndrome Resources
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