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Cauda Equina Syndrome

   

Cauda Equina Syndrome

synonyms:Cauda Equina Syndrome, CES

Cauda Equina Syndrome ICD-9

Cauda Equina Syndrome Etiology / Epidemiology / Natural History

  • Etiology: severe compression of the lumbar and sacral nerve roots.
  • Left untreated patients may develop permanent bowel, bladder and sexual dysfunction with severe personal and social implications.

Cauda Equina Syndrome Anatomy

  • Central disk prolapse at L4-5 or L5-S1 with or without a congenitally narrow spinal canal or osseous hypertrophy can lead to Cauda Equina syndrome.

Cauda Equina Syndrome Clinical Evaluation

  • Severe bilateral leg pain, weakness, saddle anesthesia (perianal numbness), bowel/bladder symptoms (urninary retention early, urine/bowel incontinence late), impotence (sexual dysfunction).
  • May present as an acute loss of perianal sensation and sphincter disturbances, chronic back pain with or without sciatica, or slowly progressive numbness with urinary tract symptoms (Lavy, BMJ 2009;338:881).

Cauda Equina Syndrome Xray / Diagnositc Tests

  • MRI indicated to evaluate for L4-5 of L5-S1 disc herniation. CT may be used if MRI is not urgently available.
  • 87% recover normal bladder function if decompressed within 24 hours. 43% recover normal bladder function if decompressed after 24 hours.

Cauda Equina Syndrome Classification / Treatment

  • Treatment = emergent decompression, discectomy. Outcomes are worse with decompression done after >24 hours. (Shapiro S, Spine 2000;25;348).

Cauda Equina Syndrome Associated Injuries / Differential Diagnosis

Cauda Equina Syndrome Complications

  • Urologic dysfunction
  • Chronic pain
  • Sexual dysfuction
  • Permanent weakness

Cauda Equina Syndrome Follow-up Care

Cauda Equina Syndrome Review References

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