Cauda equina syndrome

Cauda equina syndrome

Cauda equina syndrome is a condition when a group of nerve roots (cauda equina) at the bottom of the spinal cord experiences pressure. This condition is classified as serious and needs to be treated immediately.

Nerve roots act as a link between the brain and lower body organs. Its function is to send and receive sensory and motor signals, to and from the legs, feet, and pelvic organs. If the nerve roots are compressed, the signal will be cut off thereby affecting the function of certain parts of the body.

If left untreated, cauda equina syndrome can cause permanent paralysis, urinary and fecal incontinence, and sexual dysfunction. Even sometimes, emergency treatment is not able to restore the patient's body functions as a whole.

Causes of Cauda Equina Syndrome

Cauda equina syndrome is a complication of conditions that cause inflammation or entrapment of the nerves at the bottom of the spine. These conditions can be abnormalities, injuries, infections, bleeding, or tumors.

One of the conditions that often causes cauda equina syndrome is disc herniation or herniated nucleus pulposus (HNP) , which is a displacement of the spinal disc.

Several other conditions that can also cause cauda equina syndrome are:

  • Infection or inflammation of the spine
  • Spinal stenosis
  • Severe injury to the lower spine, for example from an accident, fall, or shot
  • Birth defects
  • Arterial vein malformation
  • Tumors on the spine
  • Bleeding in the spine
  • Spinal anesthesia
  • Complications after spinal surgery
  • Complications of ankylosing spondylitis

Risk factors for cauda equina syndrome

There are several factors that can increase a person's risk of developing cauda equina syndrome, namely:

  • Aged
  • Have a history of disc herniation in the family
  • Are overweight or suffer from obesity
  • Frequently lifting or pushing heavy objects
  • Have suffered a back injury from a fall or accident

Symptoms of Cauda Equina Syndrome

The symptoms of cauda equina syndrome vary and develop gradually. Complaints experienced by sufferers can be in the form of:

1. Pain in the lower back, including:

  • Pain that feels sharp and stabbing in the lower back area
  • Pain along the pelvis that radiates from the buttocks down the legs, in either one or both legs ( sciatica )
  • Numbness in the groin area
  • Reduced or absent lower limb reflexes
  • Weakness in the leg muscles

2. Digestive disorders, including:

  • Fecal incontinence
  • Difficulty holding back the urge to defecate
  • Constipation
  • Numbness in the anus

3. Disorders of the bladder, namely:

  • Inability to urinate (urine retention)
  • Urinary incontinence
  • Reduced sensation when urinating
  • Inability to control or resist the urge to urinate

When to see a doctor

Cauda equina syndrome is an emergency condition. Therefore, immediately seek medical help at the hospital if you experience the symptoms as above.

It should be noted, the symptoms of cauda equina syndrome can resemble the symptoms of other diseases. Therefore, an examination by a doctor needs to be done to make sure the symptoms are not caused by other conditions.

Diagnosis of Cauda Equina Syndrome

The doctor will ask the patient to explain the symptoms experienced in detail, as well as ask the patient and family medical history. After that, the doctor will carry out a physical examination, to test the patient's balance, strength, coordination, and reflexes in the legs and feet.

During a physical examination, the doctor will instruct the patient to sit, stand and walk using his toes (tiptoes) or heels. The doctor will also ask the patient to raise the leg in a lying position, as well as bend forward, backward or sideways.

Several scan tests will also be carried out to confirm the diagnosis, namely:

  • Myelography, to detect pressure on the spinal cord or nerves using X-ray photo procedures and contrast fluid injections
  • CT scan, to produce pictures of the condition of the spinal cord and surrounding tissues from various angles.
  • MRI, to produce images of the spinal cord, nerve roots, and around the spine in more detail
  • Electromyography , to evaluate and record electrical activity in muscles and nerve cells.

Treatment of Cauda Equina Syndrome

In patients who have been diagnosed with cauda equina syndrome, doctors will perform surgery, to relieve pressure on the endings of the spinal nerves. If cauda equina syndrome is caused by a herniated disc, surgery will be performed on the cushioning areas of the spine, to remove material pressing on the nerves.

Surgery should be performed within 24–48 hours of symptoms appearing, to prevent nerve damage and permanent disability.

Postoperative treatment will be carried out on patients after undergoing surgery. Some actions that can be taken are:

Drugs

The doctor will give several types of drugs to relieve or prevent other conditions that the patient may experience after surgery, namely:

  • Corticosteroids , to reduce inflammation
  • Pain relievers, such as paracetamol, ibuprofen, to oxycodone , to relieve pain
  • Antibiotics , to treat infection
  • Medications to control bladder and bowel function, such as tolterodine or hyoscyamine

Radiotherapy or chemotherapy

This method of treatment can be used as a follow-up after surgery for cauda equina syndrome caused by spinal tumors.

Physiotherapy

In patients who have difficulty walking as a result, the doctor will suggest physiotherapy measures. The medical rehabilitation doctor will plan a therapy program that can help restore the patient's leg strength.

It should be noted that the patient's body function cannot immediately return to normal, because the recovery of this condition depends on the level of nerve damage experienced by the patient. For bladder and bowel function, it may take several years to return to normal.

Complications of Cauda Equina Syndrome

If not treated immediately, cauda equina syndrome can cause several complications, namely:

  • Permanent paralysis Suppressed
    nerves can suffer permanent damage if left untreated, resulting in permanent paralysis, especially in the legs.
  • Urinary and fecal
    incontinence This condition occurs when the body has difficulty controlling urination ( urinary incontinence ) or defecation ( fecal incontinence ), due to disturbances in nerve function.
  • Sexual dysfunction
    Cauda equina syndrome can also cause disruption of nerve function in the reproductive organs, especially in men.
  • Depression
    Difficulty in carrying out daily activities can have an impact on the quality of life of sufferers and cause depression.

Prevention of Cauda Equina Syndrome

Cauda equina syndrome is difficult to prevent because it often results from an unpredictable injury or trauma. The best thing that can be done is to do an early examination and treatment when experiencing low back pain . That way, complications from these conditions, including cauda equina syndrome, can be prevented.

In addition, there are several other things that can be done to prevent cauda equina syndrome, including:

  • Do not use drugs , because spinal infections can occur through the use of shared needles
  • Drive carefully and use safety to avoid accidents
  • Don't lift things that are too heavy
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