How to recognize and treat cauda equina syndrome according to experts

To understand what is called in medicine cauda equina syndromewe must start with a brief anatomy lesson. This is how the doctor details it to us Angel Horcajadas Almansa, neurosurgeon at the Vithas Institute of Neurosciences and neurosurgery coordinator at Vithas Granada Hospital. “The spinal cord is located within the vertebral column, in the so-called spinal canal, which extends from the cervical region to the end of the sacrum. However, the cord does not reach the end of the spinal canal but usually ends at the level of the last dorsal or first lumbar vertebra, and from there, within the canal, only the nerve roots that leave the spinal cord and go to the lower limbs. Due to its morphology This bundle of nerves is called the horse’s tail. due to its similarity to the appendix of said animal,” indicates the specialist.

He also adds that these nerve roots are responsible for sensory and motor function in the lower bodyincluding the legs, feet and pelvic organs. “The ability to walk, control the bladder and bowel, and sexual function can be affected if damage occurs in this area,” he tells us.

Cauda equina syndrome is a serious medical condition which occurs when the cauda equina nerve roots, located at the lower end of the spinal cord, become compressed and damaged. The doctor explains to us that this compression can result in a series of debilitating symptoms that require immediate medical attention to prevent permanent damage.

What are the causes that cause its development?

This syndrome can be, as the doctor explains to us, the result of several causes, including the following:

• Lumbar disc herniation: The most common cause is a herniated disc which puts pressure on the nerve roots. Even though it is the most common cause, it is estimated that only 2 to 6% of herniated discs will cause compression of the cauda equina. The intervertebral discs have a kind of gel inside them called the nucleus pulposus, which sometimes protrudes backwards, where the spinal canal and nerve roots are located. These are usually large hernias that are usually associated with a narrow spinal canal.
• Trauma: Injuries to the lower back can damage nerve roots.
• Spinal tumors: Tumors can grow and compress the cauda equina.
• Infections: Infections such as epidural abscesses can lead to this condition.
• Post-surgical complications: Rarely, spinal surgery can cause this syndrome.
• Rarely vascular problems such as dural fistulas that generate an increase in venous pressure in the cauda equina, with consequent congestion.

Is it a problem that can be prevented?

Taking into account the causes already explained, the prevention of this syndrome is based on prevent back injuries, since the most common cause is a herniated disc. “Thus, you should avoid making efforts or lifting weights with the spine in flexion, and take care of our back through physical exercise aimed at strengthening the lumboabdominal muscles frequently and avoiding overweight. Tobacco also contributes to disc degeneration, so quitting smoking benefits our back,” he recommends.

What are the symptoms of this health problem?

Symptoms of cauda equina syndrome can vary, but the most common include:

• Intense lower back pain: Severe pain in the lower back that may radiate down the legs.
• Bladder and bowel dysfunction: Loss of control over urination and defecation, which may manifest as incontinence or retention.
• Weakness and numbness: Sensations of weakness and numbness in the legs and feet, especially in the saddle area (inner thighs).
• sexual dysfunction: Erection problems in men and decreased sensitivity in women.

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This confirms the diagnosis

As we pointed out before, quick diagnosis is crucial for prevent permanent damage. “The most important thing is to suspect the clinical picture. In a patient with intense lumbar pain and swelling of the genital region, we must suspect involvement of the cauda equina. In case of suspicion, the patient should be asked about possible alteration of sphincters. The clinical examination will include examination of strength and sensitivity, especially in the saddle area. In cases of herniated discs or trauma, symptoms appear quickly, while in tumors development is usually slower“, the doctor details us.

The diagnosis is usually made in emergency services, where they can sometimes go unnoticed, since low back pain is a very common reason for consultation. That is why it is important to investigate other associated symptoms carefully. “If you suspect cauda equina syndrome, you have to be diligent because time is crucial and perform a Urgent lumbar MRI”, indicates the Vithas doctor.

Cauda equina syndrome treatment

If it is confirmed that there is compression of the cauda equina the treatment is surgical. The specialist emphasizes that prompt intervention can make the difference between a successful recovery and permanent consequences. It also summarizes possible variables that influence the evolution and prognosis of the disease:

• If he picture is of short evolution and fast, As with herniated discs, urgent treatment must be performed, since the possibility of recovery is related to the hours of duration of the symptoms and their severity.
• If the symptoms have started progressively and slower, the treatment can be done deferred, but always highly preferential.
• If it is an infection, In addition to decompressing, antibiotics must be combined.
• If it is trauma and there is a bone fragment compressing the canal, it must also be operated on urgently.

“After decompression it is important to complement with a rehabilitative treatment not only motor function, but also sphincter function,” he says.

What is the prognosis of a person diagnosed with this syndrome?

The prognosis of cauda equina syndrome depends on how quickly it is diagnosed and treated. The doctor tells us that early intervention can lead to significant recovery, while delays can result in permanent neurological damage. Complications may include:

• Permanent disability: chronic weakness, numbness and loss of bladder and bowel control.
• Chronic pain: persistence of pain despite treatment.
• Sexual dysfunction: ongoing problems in sexual function.

“It is therefore a rare entitybut of vital importance because the diagnosis and early treatment depends on future quality of life of the patient”, he concludes.