Cauda Equina Syndrome (CES)

Cauda equina syndrome is a clinical condition caused by a significant compression of the nerve roots contained at the lumbar spine thecal sac called Cauda Equina Nerves. The clinical features of CES are vary depending on the degree of the pressure, level of the spine affected,  underlying cause and the time latency of the symptoms development. Cauda equina nerves supply motor, sensory and autonomic functions to the lower limbs and sphincters. The most common cause of CES is an acute, large disc prolapse at the lumbar spine. However, infection, fractured vertebra or tumour can not be excluded. CES can be classified as an acute and or complete CES or subacute/incomplete CES.

Most of the times, acute CES is a medical emergency and needs to be operated on within 24 hours from the initial symptoms of bowel and bladder disturbance. Failure of early diagnosis and immediate management may leave the patient with life changing consequences includes loss of bladder, bowel and /or sexual control.

Symptoms

CES clinical features are varied but mostly initiated with a physical activities followed by back pain, leg pain which can progress to the incontinence of urine associated  with numbness in the area of the anus and genitalia (saddle  anaesthesia or perianal numbness), Some times insidious onset of sphincters disturbance may start days after initial back pain.  Patients also may have weakness or numbness of the leg or foot or sexual dysfunction. To complete and confirm the diagnosis of CES, clinical examination of the patient which focus on the function of sphincters(anal tone and perianal sensation), and investigation in form of urgent MRI scan.

Management

The keystone of management of this serious condition is early diagnosis and early surgery before the damage of the cauda equina nerves which could be permanent. The treatment is variable, depending on the underlying cause, however, in all cases, urgent nerves decompressive surgery should be done within 24-48 hours of onset of the symptoms. It is recommended that all cases suspected to have this condition, should attend A&E directly to be assess by one of the neurosurgical or spinal team