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What is Cauda Equina Syndrome and What are the Causes?
The clue is in the name and taken from the Latin equine for horse to describe the mass of nerve roots at the lower end of the spinal canal that form a ‘mare’s tail’ or ‘cauda equina’. These branch off the lower end of the spinal cord, joining other nerves which travel towards the bladder anus and feet. Cauda Equina Syndrome is a serious and potentially debilitating condition in which there is an acute loss of functions in the lumbar region, bladder and anal sphincters and legs.
Anything which compresses or disturbs the function of the cauda equina may disable these nerves. This can include many of the conditions listed on this website. A central disc prolapse is the most common cause, although chronic spinal inflammatory conditions may combine to cause the onset of this syndrome. These include Paget’s disease, stenosis and spine instability, injury or trauma including wounding, surgery and anaesthetics. At the Spinal Foundation we feel that there is an element of susceptibility that renders particular sufferers vulnerable.
What are the Symptoms?
The compressed nerves may lead to rapid onset of muscle and sphincter weakness. Misleadingly there may be no signs of pain in the back or legs. Alternatively, the patient may be ambulant and only complaining of sexual dysfunction, lack of bladder (retention with overflow) or bowel control (anal incontinence) and so-called saddle anaesthesia( a feeling of numbness around the anus, scrotum or vagina). By contrast, the weakness in the legs may be attended by pain and lack of ankle reflexes.
How is the Condition Treated?
This condition is deemed a surgical emergency. An urgent MRI scan should be performed and surgical decompression to relieve pressure upon the trapped nerves is recommended within eight hours of onset. However, even such rapid intervention may fail to avert residual symptoms of weakness of the legs or sphincter malfunction or sensory loss. Depending upon the actual cause of the condition, this will centre on decompression and may involve removal of abnormal bone growths, lesions, tumours or haematoma following surgery or trauma, with radiotherapy or chemotherapy as appropriate. If a bacterial infection is the cause it can be treated with antibiotics after decompression laminectomy. Alternatively, inflammatory conditions can be treated with steroids and decompression as required.
What are the Likely Outcomes?
Recovery is dependent upon many factors, the most important of which is the severity and duration of compression upon the damaged nerve. As a general rule the longer the time before intervention, the greater will be the damage caused and residual impairement. Damage can be so severe and/or prolonged that nerve re-growth is impossible and damage will be permanent. Where the nerves have been damaged but are still capable of re-growth, recovery time is widely variable. Delayed or severe nerve damage can mean up to several years' recovery time because nerve growth is exceptionally slow. In most cases irreversible damage appears to occur at the outset and determines the outcome despite rapid and correct treatment.