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Cauda Equina Syndrome:

This page is intended as a patient/relative information source only. It is not a substitute for professional medical advice.

What Is Cauda Equina Syndrome?

Cauda equina syndrome is a group of symptoms that require urgent investigation and treatment.

It is a rare syndrome that many General Practitioners may not see in their lifetime but it is very important not to miss.

What Causes Cauda Equina Syndrome?

Cauda equina syndrome is caused by impingement on the nerves of the cauda equina (the bottom bit of the spine) and can arise as a result of a number of pathologies:

  • Most commonly it is caused by a "slipped disc" in the lower spine.
  • It can also be caused by a tumour pressing directly on to the nerves. These tumours can originate from the spinal cord itself or be metastatic; having spread from cancers elsewhere.
  • Cancers of the blood cells such as lymphoma are even occasionally responsible for the compression.
  • Otherwise this syndrome can arise as a result of trauma, infection or blood clot (following an operation or procedure).

How Is Cauda Equina Syndrome Diagnosed?

Clinical Presentation:

Cauda equina can present in a variety of ways. Commonly patients experience lower back pain and altered sensation in the buttocks or legs. These sensations can include numbness, pins and needles or weakness. These symptoms are very common and people with just these problems are very unlikely to actually have cauda equina syndrome. It is important to check continence (the ability to control bowel and bladder). Bladder symptoms can include incontinence and an inability to pass urine. These signs, if present are concerning and need very urgent review with your GP or local A&E department.

Assessment:

Prompt examination is required. The doctor will examine the legs but also the area around the back passage to check that the nerves that control bowel continence are working correctly. The red flags to look for include:

  • Saddle anaesthesia
  • Loss of anal tone
  • Faecal incontinence
  • Urinary incontinence
  • Inability to pass urine
  • Sexual dysfunction
  • Nerve problems in the legs
  • Severe low back pain

Even in experienced hands, clinical examination alone is not always enough to diagnose cauda equina syndrome and it may be necessary to perform an MRI scan.

Investigation:

The most effective method for looking at the spinal cord and its roots is through magnetic resonance imaging (MRI) scans. These scans are best for visualising the relevant soft tissues.

The above image is an MRI showing a slipped disc in the spine, causing cauda equina syndrome.

How Is Cauda Equina Syndrome Treated?

If symptoms develop rapidly early neurosurgical intervention is often needed. How urgently the surgery needs to be carried out is determined on an individual basis but in general this should be performed as relatively quickly.

The surgical options include:

  • Laminectomy: An operation on the spine to remove some of the bone and ligament that surround the spinal cord, in order to free up space around the nerves.
  • Microdiscectomy: An operation where a smaller portion of bone and ligament is removed and the surgeon will gently move the nerves out of the way to find a slipped disc and try to remove as much of the disc as is possible.

These are some of the most common operations that we perform in the Leeds Neurosurgery department.

What Is The Outlook?

Prognosis following cauda equina syndrome is difficult to predict as each case is different. If the above symptoms are causing you problems you ought to seek advice from your doctor as early recognition and intervention are crucial in some cases to reduce the risk of long-term complications.

 

Page Author: Dr Sam Neilson, March 2012


Website created and edited by Ian Anderson