Cauda equina syndrome
| Cauda equina syndrome | |
|---|---|
| The cauda equina begins at the end of the spinal cord | |
| Synonyms | |
| Pronounce | |
| Field | Neurosurgery, orthopedics |
| Symptoms | Low back pain, pain that radiates down the leg, numbness around the anus, loss of bowel or bladder control |
| Complications | |
| Onset | Rapid or gradual |
| Duration | |
| Types | |
| Causes | Disc herniation, spinal stenosis, cancer, trauma, epidural abscess, epidural hematoma |
| Risks | |
| Diagnosis | Medical imaging (MRI, CT scan) |
| Differential diagnosis | |
| Prevention | |
| Treatment | Surgery (laminectomy) |
| Medication | |
| Prognosis | 20% risk of poor outcome |
| Frequency | 1 in 70,000 a year |
| Deaths | |
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.[1] 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.[2] The onset of symptoms can either be rapid or gradual.[2]
Causes and Diagnosis[edit | edit source]
CES most commonly results from a disc herniation in the lower region of the back.[2] Additional causes include spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma.[2][1] Diagnosis of CES is typically suspected based on patient symptoms and further confirmed via medical imaging techniques such as MRI or CT scan.[2][3]
Treatment and Prognosis[edit | edit source]
The primary treatment for CES involves surgical intervention, typically through a procedure known as laminectomy.[2] However, despite surgical intervention, there may be persistent issues such as permanent bladder complications, sexual dysfunction, or numbness.[2][3] Unfortunately, approximately 20% of individuals experiencing CES may have a poor outcome, even with treatment.[2] The annual incidence of CES is roughly 1 in 70,000 people.[2] The condition was first described in the medical literature in 1934.[4]
Clinical Manifestations[edit | edit source]
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,[5]: 26 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[edit | edit source]
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[edit | edit source]
References[edit | edit source]
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