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    Cauda Equina Syndrome

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    puchio
    Cauda Equina Syndrome is a condition associated with compression of the nerve roots in the lumbosacral spine, characterized by progressive low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction. It can be caused by compression from tumors, trauma, disc herniations, or other factors. Neurogenic bladder dysfunction is a key element of Cauda Equina Syndrome. Diagnosis involves imaging like MRI or CT myelography to identify any compressive lesions, and surgical decompression is usually required if medically stable.

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    Cauda Equina Syndrome

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    puchio
    997 views3 pages
    Cauda Equina Syndrome is a condition associated with compression of the nerve roots in the lumbosacral spine, characterized by progressive low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction. It can be caused by compression from tumors, trauma, disc herniations, or other factors. Neurogenic bladder dysfunction is a key element of Cauda Equina Syndrome. Diagnosis involves imaging like MRI or CT myelography to identify any compressive lesions, and surgical decompression is usually required if medically stable.

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    Cauda Equina Syndrome

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    Cauda Equina Syndrome is a condition associated with compression of the nerve roots in the lumbosacral spine, characterized by progressive low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction. It can be caused by compression from tumors, trauma, disc herniations, or other factors. Neurogenic bladder dysfunction is a key element of Cauda Equina Syndrome. Diagnosis involves imaging like MRI or CT myelography to identify any compressive lesions, and surgical decompression is usually required if medically stable.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    997 views3 pages

    Cauda Equina Syndrome

    Uploaded by

    puchio
    Cauda Equina Syndrome is a condition associated with compression of the nerve roots in the lumbosacral spine, characterized by progressive low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction. It can be caused by compression from tumors, trauma, disc herniations, or other factors. Neurogenic bladder dysfunction is a key element of Cauda Equina Syndrome. Diagnosis involves imaging like MRI or CT myelography to identify any compressive lesions, and surgical decompression is usually required if medically stable.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Cauda Equina Syndrome

    Condition associated with compression of the nerve roots in the lumbosacral


    spine characterized by progressive low back pain, sciatica, lower extremity
    sensorimotor loss, and bowel and bladder dysfunction.

    Overview

    – Lesions involving the cauda equine are lower motor neuron lesions—patients
    may demonstrate varying degrees of lower extremity muscle weakness and
    sensory disturbance as well as decreased or absent reflexes.
    – Can be caused by compression due to tumor, trauma, disc herniation, epidural
    hematoma or abscess, spinal surgical implants, etc.
    – Neurogenic bladder dysfunction is an essential element of cauda equine
    syndrome. Dysfunction can be divided into two categories (retention and incon-
    tinence). The injury to lower motor neurons causes disruptions to reflex arcs that
    control bladder function. Loss of sensation of fullness and the inability to contract
    lead to retention and overflow incontinence.

    History

    – Do you have a history of cancer or risk factors for cancer?


    – Did you have any trauma?
    – Have you had fevers, chills, or recent weight loss?
    – Do you have bowel/bladder dysfunction?
    – Do you have saddle anesthesia or any other motor/sensory deficits?
    – When did the symptoms begin?

    © Springer International Publishing Switzerland 2017 41


    M.C. Makhni et al. (eds.), Orthopedic Emergencies,
    DOI 10.1007/978-3-319-31524-9_13
    42 J. Shillingford

    Physical Exam

    – Trauma evaluation (Appendix A)


    – Complete neurologic evaluation (Appendix A)
    – Rectal examination for decreased tone, perianal sensation
    – Neurogenic bladder dysfunction
    – Post-void residual - can indicate urinary retention
    – Bulbocavernosus reflex

    Diagnosis

    Imaging

    Diagnostic imaging should be obtained in an expedient manner; however, when the


    diagnosis is strongly suspected and diagnostic tests are not available it may be
    appropriate to recommend transfer of patient to a facility that can obtain advanced
    imaging studies.
    XR entire spine
    MRI—allows for visualization of space-occupying lesions as well as other
    potential causes of compression of neural structures.
    CT myelography—for patient unable to undergo MRI.

    Treatment

    Non-operative treatment reserved for medically unstable


    Otherwise, surgical decompression of offending lesion (tumor, disc, abscess, etc.)
    Timing of surgery
    Once a diagnosis is made and advanced imaging studies performed and reviewed,
    should proceed to surgery
    Discordance in literature for benefits of early versus delayed
    Historical “48-h” window
    RCT showing improved outcomes of surgery (<24 h) versus 48 h
    Cauda Equina Syndrome 43

    References

    Daniels EW, Gordon Z, French K, Ahn UM, Ahn NU. Review of medicolegal cases for cauda
    equina syndrome: what factors lead to an adverse outcome for the provider? Orthopedics.
    2012;35(3):414–419.
    Fehlings MG, Vaccaro A, Wilson JR, Singh A, W. Cadotte D, Harrop JS, et al. Early versus delayed
    decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute
    Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):1–8.
    Spector LR, Madigan L, Rhyne A, Darden B 2nd, Kim D. Cauda equina syndrome. J Am Acad
    Orthop Surg. 2008;16:471–9.

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