Spinal Cord Disease - Cauda Equina Syndrome

Question 1

What is Cauda Equina Syndrome?

Answer 1

A surgical emergency where the nerve roots of the Cauda Equina (at the bottom of the spine) are compressed.

Question 2

What is the Cauda Equina?

Answer 2

Collection of the nerve roots that travel through the spinal canal after the spinal cord terminates around L2/L3 (after the Conus Medullaris) : L3-S5.

Question 3

What is the Conus Medullaris?

Answer 3

The tapering down of the spinal cord at L1-L3.

Question 4

What do the nerves of the Cauda Equina Supply? (3)

Answer 4

1. Sensory : Lower Limbs, Perineum, Bladder and Rectum.
2. Motor : Lower Limbs, Anal and Urethral Sphincters.
3. Parasympathetic : Bladder and Rectum.

Question 5

Aetiology of Cauda Equina (5).

Answer 5

1. Herniated Disc at L4/L5 or L5/S1 (Commonest).
2. Tumours & Metastasis.
3. Spondylolisthesis.
4. Abscess & Infection.
5. Trauma.

Question 6

What is Spondylolisthesis?

Answer 6

Anterior displacement of a vertebra out of line with the one below.

Question 7

Red Flag Clinical Features of Cauda Equina Syndrome (7).

Answer 7

1. Saddle Anaesthesia (Perineum).
2. Loss of Sensation in Bladder and Rectum (Not Knowing When Full).
3. Urinary Retention or Incontinence.
4. Faecal Incontinence.
5. Bilateral Sciatica.
6. Bilateral Severe Motor Weakness in Legs.
7. Reduced Anal Tone in PR Exam.

Question 8

How can you ask about Saddle Anaesthesia?

Answer 8

Does it feel normal when you wipe after opening your bowels?

Question 9

Management of Cauda Equina Syndrome (3).

Answer 9

1. Immediate Hospital Admission.
2. Emergency MRI Scan.
3. Neurosurgical Input - Lumbar Decompression Surgery.

Question 10

Management of Cauda Equina Syndrome.

Answer 10

1. Emergency Decompression Surgery (Prevent Permanent Neurological Dysfunction).