Cauda Equina Syndrome
synonyms:Cauda Equina Syndrome, CES
Cauda Equina Syndrome ICD-10
Cauda Equina Syndrome ICD-9
- G83.4 Cauda equina syndrome
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