Cauda Equina Syndrome

Cauda equina syndrome (CES) is a rare medical health condition that is characterized by inflammation, compression, damage, and subsequent malfunctioning or dysfunction of nerves located at the end of the spine. These root nerves are also known as the cauda equina.  Cauda equina syndrome is a serious condition that requires immediate medical attention. If left untreated, it can result in a lot of complications, one of which includes the inability to perform locomotive movements. Cauda equina syndrome leads to lower motor neuron symptoms. It could also lead to the loss of important senses, such as the sense of touch (as concerned with the genital organs).  Since the cauda equina controls some sensory functions in the genitals, cauda equina syndrome can lead to the loss of these senses. It could be noticed when you feel unexplainable pains in the area around your back waist.The resulting complications of cauda equina syndrome if left unattended to may include:

• Pains during sexual intercourse.
• Numbed genital parts.
• The inability of the penis to rise.
• Ulcerative disorders.
• Inability to perform locomotive movements.
• Slowed fluid movement.
• Stiffened muscles around the lower back.
• Increased reflex activities within the lower back.
• Hypertonia (concentration of muscle tone).
• Fragile or brittle spinal bones.
• Possibility of spinal bone fractures.
• Growth of bones in soft tissues around the lower spine.
• Blood clot formation in the spinal region.
• Extreme sensitivity when touched on the lower back.
• Excruciating, burning, and shooting back pains.
• Inability to sense temperatures.

CAUDA EQUINA SYNDROME RISK FACTORS You are at risk of having cauda equina syndrome once you fall into one of the following groups: Those prone to have herniated disks, such as:

1. 1. Elder adults.
   2. Athletes.
   3. Weightlifters.
   4. Bodybuilders.

• Racial composition.

It is noted in statistics that Africans are at a lesser risk of getting cauda equina syndrome than people of other races in the world. However, nobody knows why this is so.

• Age.

Older adults, such as those of middle age and above, are at a higher risk of getting CES, more than the other age groups. This is probably due to the risk of stress and weakened or worn-out bones, which puts them at a high risk of osteoporosis and spinal inflammation.

• Gender.

Females are said to be more likely affected by cauda equina syndrome, than males. You are at a higher risk of getting CES if you are a cisgender female (a female from birth, who has not undergone gender reassignment) or transgender male (a female who converted to a male via gender reassignment surgery). Other risk factors include:

1. Obesity or overweight.
2. Stress.

CAUDA EQUINA SYNDROME DIAGNOSIS Cauda equina is a serious medical condition that needs to be diagnosed early to be treated immediately after being confirmed. Consult your doctor when you notice any unusual symptoms. To know if you have CES, your doctor will ask you about:

• Your medical history.
• Your daily activities.
• Your methods of exercising.
• If you get stressed out easily.
• Your noticed symptoms.
• Your current state of health.

With these questions and investigation, your doctor will carry out the following cauda equina syndrome test:

• Physical Examination Of Your Lower Back.

This may entail your doctor pressing your lower back with his thumbs, to see if you can respond sharply to his actions. Your response shows that you have sharp pains in your lower back, calling for a need to do an x-ray to check for any abnormalities.

• Scanning Of Your Bladder And Urinary Tract With X-ray.

The use of an x-ray scan will give a detailed description of how your urinary tract and bladder look like, in images.

• Checking Your Sensitivity To Catheter.

Your doctor will insert a catheter (a soft hollow tube) and let it travel to your bladder. When your doctor figures you do not respond well or normally to the catheter, this may indicate your chance of having CES. He will have to carry out one more test to find out completely.

• Magnetic Resonance Imaging (MRI) Test.

Using magnetic waves, your doctor will be able to capture images of your lower spine, to check if any bones are broken, if the cauda equina nerves are swollen, or there is any other problem in the spine.

• Computed Tomography (CT) Scan.

This is an x-ray that shows the structure of the bones in one’s body. With this scan, the doctor can find out if your lower spine is abnormal. CAUDA EQUINA SYNDROME TREATMENT The specialty used in treating cauda equina syndrome:

• Neurosurgery.
• Orthopedics.

For now, only surgery is required to treat cauda equina syndrome, to depressurize the spasms of the nerves around the lower spine and the sciatic nerve. To do this, the surgeon would remove the lamina (in your spinal canal) via a surgical procedure known as laminectomy, also known as rachiotomy, to reposition the ruptured herniated disc that is exerting pressure on the lower spine and its surrounding nerves.  Laminectomy Specialty: Orthopedics Duration: 4 to 6 hours Before the Procedure,

• Do not eat or drink the night before.
• Wear loose clothing.
• Do not wear jewelry.
• Bring a partner to stay with you for the day.
• Notify all your friends and close relations about the surgery.
• You may need to change into a hospital gown.

During the Procedure,  The orthopedic surgeon in charge of your cauda equina laminectomy will:

1. Make you lie with your face down on the surgery table.
2. Sedate you to sleep by injecting anesthesia into your bloodstream.
3. Make an incision on your lower back, over the affected spinal nerves.
4. Relocate the muscles away from your spine, as much as needed, to expose the spine.
5. Use small instruments (such as a scalpel) to remove the interfering lamina (a bone that is part of the outer wall of the spine), because of its pressure on the nerves.
6. Remove the herniated discs and additional bones, to create space in the passageway where the nerves leave the spinal canal.
7. Stitch the wounds and cover up your lower back.

After the Procedure,

• You will stay for two or more days in the hospital.
• You will feel pains at the surgery site.
• You may need walking aids for a whole week.
• Limit your normal daily routine of activities, to avoid stressing the incision site.
• Avoid soaking the incision site in water or any liquid, until your doctor permits.
• Your stitches will be removed when the wound is fully healed (about 2 weeks or a month after).
• Avoid sitting in the same spot for over 20 minutes.

SIDE EFFECTS OF CAUDA EQUINA SYNDROME SURGERY You are bound to have side effects after a cauda equina laminectomy has been performed on your lower back by an orthopedic surgeon. These include minor effects like:

• Painful feeling at the incision site.
• Swelling or redness at the incision site.
• Inability to walk on your own (about 2 weeks).

The only major side effect you are to worry about is getting infected at the incision site. CAUDA EQUINA SYNDROME RECOVERY RATE AND SURGERY RESULTS You will experience the following results when recovering from cauda equina syndrome:

1. For minor surgery, the ability to:
2. Carry out light working activities.
3. Walk on your own, within 2 weeks.
4. Partially recover within a month or half. 

• For major surgery, the ability to:

1. Partially recover after 2 months.
2. Walk on your own, after 2 weeks.
3. Do light chores after half a month.
4. Carry on your daily activities within 2 months.

However, your doctor may advise you to:

• Stay away from lifting or bending, for about 3 months.
• Start light activities only when he says so.

CAUDA EQUINA SYNDROME PROGNOSIS Cauda equina syndrome is a rare medical condition that is estimated to occur in one out of every five hundred thousand (1:500,000) people, per year. It has less than 30% risk of poor outcome in surgery, with a more than 70% rate of survival. Only a few people die during the procedures or from the syndrome itself.  Full recovery does not take place after surgery, until about 6 months later. At home, however, you may be able to move around and do some house chores that do not require a lot of energy.

Symptoms

The early symptoms of cauda equina syndrome often begin with weakness, numbness, and pains around the spinal region. Peculiar signs and symptoms of cauda equina syndrome include:

• Inability to urinate.
• Numbness or lost sense of feeling on the genital area.
• Sciatica (pains in the back or legs).
• Bladder dysfunction.
• Bowel malfunctioning.
• Numbness and radiating pains in the buttocks.
• Loss of balance.
• Weakness of muscles around your waist.

Causes

The primary cause of cauda equina syndrome is disc herniation (the protruding of a disk nucleus into the spinal cord), but there are other causes. The causes of cauda equina syndrome are complex. They pose serious complications if not diagnosed and treated early. They include:

• Infections in the spine.
• Inflammation of the spine.
• Wounds in the lower back and waist.
• Birth defects.
• Injuries and deformities of the spine.
• Spinal surgery side effects.
• Narrowing of the spine.
• Tumors or cancerous growth in the spine.

FAQ

Is cauda equina syndrome a permanent disability?

As uncommon as it is, cauda equina syndrome is not a permanent disability. Hence, you cannot receive any disability benefits for it, unlike scoliosis and paralysis. The syndrome can subside 6 months after a laminectomy procedure is carried out.

Can cauda equina syndrome be cured without surgery?

No, cauda equina syndrome requires surgery to subside or be cured. Medications cannot play a part in decompressing the spinal canal in which the nerves are affected in the lower back. Laminectomy is the best surgery that can aid in relieving the syndrome. 

What are the first signs of cauda equina syndrome?

The first signs you will notice before diagnosing cauda equina syndrome are pains in the lower back, thighs, and butt, as well as numb genitals.

What happens if cauda equina syndrome is left untreated?

If left untreated, cauda equina syndrome can lead to genital abnormalities such as erectile dysfunction and numb groins, as well as paralysis.

How common is cauda equina syndrome?

Cauda equina syndrome is not a common medical condition. It occurs in 1 out of every 500,000 people every year. It is a rare and uncommon condition that could lead to paralysis, severe back pains, and erectile dysfunction if left untreated. Cauda equina syndrome has an 80% survival rate.