Cauda Equina Syndrome

Cauda Equina Syndrome is a serious neurological condition that affords the sufferer acute loss of function of nerve elements of the spinal canal beneath the Conus, the bottom of the spinal cord. Below the Conus a canal contains a mass of nerves called the Cauda Equina, which is latin for 'Horses Tail', this is a good description of what the body of nerves looks like. The Cauda Equina branches off the lower end of the spinal cord and contains the nerve root from L1-5 and S1-5. A lesion which compress or disturbs the function of the cauda equina may disable nerves although the most common is a central disc prolapse.

Causes of Cauda Equina Syndrome

Although the Cauda Equina is protected by the backbone it a still remains vulnerable to injury and trauma. There are two groups of causes.

Congenital - from birth:
Spina Bifida
Tumours of the Cauda Equina

and acquired Cauda Equina Syndrome:
Injury and trauma
Following medical procedure
Disc Herniation - slipped or prolapsed disc
Tumour of the Cauda Equina
Vescular problems of the CE
Infections such as Cytomegalorvirus
Symptoms of Cauda Equina Syndrome

Most cases are sudden, however some progress slowly with none or little pain.

Low back pain
Dysfunction of pelvic organs namely:
Bowel
Bladder
Sexual organs
Other symptoms include:
Walking difficulty
Severe unexplained pain

Treatment of Cauda Equina Syndrome

Patients should be referred immediately for a neurosurgical consultation. Urgent surgical spinal decompression is required for most patients to prevent permanent damage.

Immobilise spine if Cauda Equina Syndrome is due to injury. Surgery required to remove blood, bone fragments, tumour, herniated disc or abnormal bone growth.

Lesion debulking is required for space occupying lesions, e.g. tumours, abscess.

If surgery cannot be performed, radiotherapy may relieve cord compression caused by malignant disease.

Other treatment may be useful in certain patients, depending on the underlying cause of the Cauda Equina Syndrome:
Anti-inflammatory drugs, can be effective in patients with inflammatory causes, e.g. Ankylosing Spondylitis.
Infection causes should be treated with appropriate antibiotics.
Patients with spinal neoplasms should be evaluated for chemotherapy and radiation therapy.
Postoperative care includes addressing lifestyle issues, e.g. obesity, and also physiotherapy and occupational therapy, depending on residual lower limb dysfunction.

The number of days lost at work due to back problems in the UK alone is huge. There are many reasons for back pain, for instance Sciatica. Accurate diagnosis and treatment are the cornerstone of the medical profession. It is generally accepted that a major factor in the successful treatment and recovery of Cauda Equina Syndrome is for surgery to decompress the nerves to be completed within 48 hours from the onset of symptoms. For this to happen the diagnosis needs to be swift and accurate.

Clear warning signs present themselves and include

Negligence by Medical Staff

The number of days lost at work due to back problems in the UK alone is huge. There are many reasons for back pain, for instance Sciatica. Accurate diagnosis and treatment are the cornerstone of the medical profession. It is generally accepted that a major factor in the successful treatment and recovery of Cauda Equina Syndrome is for surgery to decompress the nerves to be completed within 48 hours from the onset of symptoms. For this to happen the diagnosis needs to be swift and accurate.

Clear warning signs present themselves and include:

Lower back pain, found tender to the touch
Abnormal reflexes
Loss or reduction of sensation in the 'saddle area'
Pain in legs
Muscle weakness or wasting if syndrome has been undetected for longer periods
Anal and or bladder dysfunction
There are many occasions when these warning signs are failed to be diagnosed or misdiagnosed as another condition.
These medical errors may result in life changing circumstances and result in the compensation claims.
Unfortunatley on many occasions frontline healthcare providers miss the warning signs that present for this type of injury. So professionals such as a GP, Physiotherapist, and Chiropracter are those who miss the warning signs of a CES trauma. Hospital professionals too are vulnerable to CES diagnosis errors, such as A&E Staff, Consultant, Surgeon. Misdiagnosing or failing to diagnose CES is considered as medical or clinical negligence

CES may well leave the failed diagnosed, late diagnosed or misdiagnosed patient with severe injury.