Cauda Equina Syndrome

Abstract

Cauda equina syndrome (CES) is a relatively uncommon condition typically associated with a large space-occupying lesion within the canal of the lumbosacral spine. It is one of the few spinal surgical emergencies and its prompt diagnosis and surgical treatment are of paramount importance as, otherwise, patients could be left with permanent and disabling neurological deficits involving lower limb sensorimotor function, bladder, bowel and sexual function. Furthermore, and as a result of perceived delays in diagnosis and treatment culminating in a suboptimal functional outcome, CES carries a disproportionately high medicolegal profile. This article aims to provide a simple overview of lumbar disc prolapse, CES and its initial management in primary care.

Intradural Cauda Equina Tumors: Early Surgical Experience of a Small Neurosurgical Team

“…3 It is a rare clinical situation and is one of the few surgical emergencies in neurosurgical practice. 7 The clinical presentation of CES includes saddle sensory deficit with motor, bowel, bladder, and sexual disorders. 17 MRI is a very efficient tool for diagnosis and differential diagnosis of CES etiology and is characterized by being highly sensitive in detecting the lesions, their site, and size and being simple and noninvasive.…”

“…15 CES can occur due to compression of cauda equina rootlets, with the most common cause being a large central L4-L5 and L5-S1 lumbar disc herniation. 7,12 Less common causes are spinal injury, postmanipulation, spinal anesthesia, space-occupying lesions such as hematoma, abscess, schwannomas, ependymomas, lipomas, teratomas, arteriovenous malformations, and metastasis, ischemic injury, and inflammatory disorders. 7,14 The prognosis in cases with CES is influenced by many clinical variables such as duration of symptoms, the timing of surgery, and severity of symptoms.…”

“…7,12 Less common causes are spinal injury, postmanipulation, spinal anesthesia, space-occupying lesions such as hematoma, abscess, schwannomas, ependymomas, lipomas, teratomas, arteriovenous malformations, and metastasis, ischemic injury, and inflammatory disorders. 7,14 The prognosis in cases with CES is influenced by many clinical variables such as duration of symptoms, the timing of surgery, and severity of symptoms. 8 In this study, we present our experience and clinical outcome in managing intradural cauda equina tumors in our neurosurgical unit.…”

Role of Invasive Urodynamic Studies in Establishing Cauda Equina Syndrome and Postoperative Recovery

“…It constitutes 0.07%-2% of Lumbar disc prolapse (LDP). 3,4 Confirming the diagnosis of CES based purely on symptoms and signs is unreliable and usually associated with high false positive rate. A missed diagnosis can permanently disable the patient whereas a misdiagnosed patient may have to undergo a surgery which does not address the cause of his bladder symptoms, there by adding to the morbidity of the procedure.…”