Cauda Equina Syndrome

Caused by compression of the nerve roots caudal to the level of spinal cord termination

Aetiology

  • Most common cause is compression arising from large central lumbar disc herniation at the L4/L5 and L5/S1 level

Clinical presentation

Symptoms

  • Classically bilateral leg pain, can be unilateral or with no leg symptoms
  • Loss of motor or sensory function of bowel/bladder
    • Loss of control/awareness (NOT constipation or increased urinary frequency)
  • Perineal/saddle anaethesia
  • Widespread or progressive motor weakness in the legs or gait distribution

Signs

  • PR exam - loss of anal sphincter tone

Investigations

  • Urgent MRI to determine level of prolapse

Management

  • Urgent discectomy

Complications

  • Prolonged compression can cause permanent nerve damage requiring colostomy and urinary diversion
  • Even with prompt surgical intervention, significant number of patients have residual nerve injury with permanent bladder and bowel dysfunction