Cauda Equina Syndrome

The cauda equina is the sack of nerve roots (nerves that leave the spinal cord between spaces in the bones of the spine to connect to other parts of the body) at the lower end of the spinal cord. These nerve roots provide the ability to move and feel sensation in the legs and the bladder.

This condition results when a spinal disc presses on the nerve roots. It cuts off sensation and movement. It can affect control of the bladder and the bowel.

Without quick treatment, problems can occur, including permanent paralysis, not being able to empty the bowel or bladder properly, loss of sexual sensation and other problems can occur.

Symptoms

Symptoms may be slow to appear and may vary in their intensity.

A person should see his or her doctor if he or she has:

  • Lost the ability to control his or her bladder or bowels
  • Less or changed sensation between the legs or over the buttocks, the inner thighs, the back of the legs, the feet or the heels
  • Pain, numbness or weakness in one or both legs. This may cause stumbling or trouble getting up from a chair.

Causes and Risk Factors

This condition may be caused by a ruptured disc (which provides a cushion between the bones of the spine and space for the nerves to pass from the spinal cord to other parts of the body), a tumor, infection, a fracture or a narrowing of the space through which the spinal cord passess may bring this on. It may also be caused by violent impact such as a car crash, a fall from a great height or an injury like a gunshot or stabbing that enters the body.

Sometimes children are born with spinal problems that cause this condition.

Diagnosis

A doctor will review the symptoms, do a physical exam and order imaging studies.

The exam will focus on the patient's stability, sensation, strength, reflexes and ability to move. The doctor might check the tone and numbness of the muscles that are used to move solid wastes from the intestines outside the body. Blood tests may be ordered.

Additionally, the doctor may order:

  • X-rays
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT scans)

Treatment

This is a serious medical condition. Treatment needs to be given quickly. This can include:

  • Surgery to take the pressure off the nerves is the best treatment. Treating patients within 48 hours provides an important advantage in improving sensory and motor deficits as well as bowel function.
  • Rest and drugs to reduce swelling and pain

Additionally, it may be helpful to have help from an occupational therapist (someone who assists people in learning how to do activities of daily living when they have an injury or condition that limits their movement), social worker or continence counselor (who assists people who have problems controlling their bladder or bowels to properly get rid of wastes) or to join a support group.

Resources at Cedars-Sinai