Cauda Equina Syndrome is a Surgical Spine Emergency: Signs & Symptoms

by Jason Lauf, OMSII

Low back pain is the second most common reason for patients to visit a primary care physician. Each year, the prevalence of low back pain among patients ranges from 15-45%. There are several conditions that could cause low back pain, some of which include tight musculature, herniated discs, tumors, infection, and lumbar stenosis.

The latter causes, have potential to cause severe outcomes. One of these outcomes is cauda equina syndrome. Although uncommon (occurs is 1-6% of backachelumbar disc herniations), cauda equina syndrome is a surgical emergency and must be treated immediately. Onset of symptoms can range from acute to gradual, although it is usually acute. It is the result of pressure placed on the nerves in the lower lumbar area spinal cord. This condition is called “cauda equina” (which means horse’s tail in Latin) because in the lower lumbar area, the spinal cord fans out into what looks like a horse’s tail made of spinal nerves. These nerves are the nerves that are compressed in the condition of cauda equina syndrome.

Some red flags of cauda equina syndrome are:

  • Low back pain
  • Saddle paresthesia – numbness and tingling along the inner thighs and lower groin, the areas that would be in contact if you were sitting in a saddle
  • Bowel incontinence – problems holding in urination or defecation
  • Sexual dysfunction

Physicians diagnose cauda equina through a physical exam, CT myelogram, and MRI. The physical exam includes observing a patient’s walk, if the patient is able to stand up out of chairs without the use of arm rests, and checking anal muscle tone. The syndrome is classified as incomplete and complete based on urinary retention. If there are urinary problems such as poor stream or loss of sensation, the condition is classified as incomplete. Complete syndrome is characterized by painless urinary retention with overflow incontinence (the buildup of urine to cause leaking). The treatment for cauda equina syndrome is dependent upon the underlying cause of the compression. If it is due to inflammation or infection, anti-inflammatories or antibiotics can be used as a first line to decompress the nerves. If these fail to relieve symptoms within 24 hours or if the compression is due to other causes, surgery is done to remove the pressure on the nerves. If symptoms persist longer than 24 hours without treatment, the risk of permanent paralysis and incontinence problems increases.

The outcome of surgical decompression is high for relief of symptoms and recovery rates. Patients that have shown better results when the surgery has been conducted within 48 hours of symptom onset. The only correlation between expected surgical outcome and persistence of symptoms is the time from onset to surgery. Although better results have been shown within 48 hours, the optimal time between onset and surgery is less than 24 hours.

There is no way for patients to actively prevent the disease. The underlying cause of the syndrome is unable to be predicted and stopped by the patient.

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