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Saddle Anesthesia

Cauda Equina Syndrome: a review of all you need to know

Teaser: 

Vega-Arroyo Miguel, MD,1 Perry Dhaliwal, MD, MPH, FRCSC,2

1 Section of Neurosurgery, Department of Surgery, University of Manitoba.
2 Assistant Professor of Neurosurgery, Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba.

CLINICAL TOOLS

Abstract: Cauda equina syndrome (CES) is the collection of signs and symptoms produced by severe compression of the lumbar spinal nerves that form the cauda equina. The compression can be caused by lumbar degenerative changes, intraspinal tumors, epidural hematoma, and infections. Rapid diagnosis and treatment are paramount as CES requires emergent surgical decompression. With delay, the patient could develop permanent neurological deficits including loss of lower limb sensorimotor function, bladder, bowel, and/or sexual dysfunction. Unfortunately, even with expeditious surgery, neurological improvements remain unpredictable. Failure to fully explain the possible prognoses can involve all the healthcare providers in medicolegal consequences.
Key Words:Cauda Equina Syndrome, Spine Emergency, Urinary retention, MRI scanning, Saddle Anesthesia.

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1. Cauda Equina Syndrome results from pathologies that compress the nerves in the lumbosacral spinal canal, most commonly due to an acute lumbar disc herniation.
2. Early diagnosis is crucial and is made clinically by distinctive symptoms of saddle anesthesia, acute urinary incontinence combined with acute back and leg pain.
3. The most consistent early clinical sign of CES is urinary retention, and the prognosis is worse when present.
4. Urgent MRI is the study of choice and should be performed to confirm or rule out CES.
5. Surgery is highly recommended within 24 hours after CES is identified.
1. Cauda Equina Syndrome is caused by a large space-occupying lesion within the central canal of the lumbosacral spine, most commonly a large disc herniation. However, compression can also be caused by lumbar degenerative changes, intraspinal tumors, epidural hematoma, and infections.
2. Cauda equina syndrome generally presents with varying degrees of sensory loss and motor weakness in the lower extremities, saddle anesthesia, and bowel/bladder dysfunction (these last 2 are required to establish the diagnosis of CES).
3. The main clinical feature between differentiating Cauda Equina Syndrome vs Conus Medullaris Syndrome, is the absence of UPPER MOTOR NEURONS findings in CES).
4. About 70% of patients with cauda equina syndrome have a previous history of lower back pain and/or sciatica.
5. Although the prognosis is largely determined by the preoperative severity of neurological deficits, early surgery improves the chance of significant recovery so patients with CES require urgent surgical intervention.
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Related Terms: Back Health, cauda equina syndrome, spine emergency, urinary retention, MRI scanning, Saddle Anesthesia