Cauda Equina profoma

Question 1

What is cauda equina?

Answer 1

Spinal emergency where nerves below spinal cord (in the cauda equina) are compressed

These nerves supply the bladder, bowels & sensation to the bottom and back passage.

Question 2

Aetiology of cauda equina

Answer 2

Disc herniation

Spondylolisthesis

Tumour e.g. myeloma, bony metastasis, primary sacral tumour.

Spinal stenosis

Epidural abscess

Trauma e.g. gunshots, falls or car accidents

Question 3

Clinical presentation of cauda equina

Answer 3

RED FLAGS:

• Bowel, bladder or sexual dysfunction - e.g. urinary & faecal retention or incontinence.
• Back pain
• May have sciatica
• Bilateral paraesthesia
  Bilateral leg pain
• Saddle anaesthesia - perineum, buttocks, anus, groin, upper thighs : due to compression of nerve in cauda equine, which supply motor function to bowel & bladder sphincters & sensation to the perineum.
• Bilateral motor deficit
• Perineal pain & paraesthesia -area between anus & the genitals.
• Reduction or loss of lower limb reflexes
• History of lumbar disc herniation, spinal stenosis, spinal cancer, infection e.g. TB or spinal surgery.

Question 4

Investigation of cauda equina

Answer 4

MRI!

Examination may reveal a distended bladder & weakness of some muscles

Rectal examination reveals marked reduction in external spinchter tone.

CT scan - but discs are not easily seen on scan.

Myleogram - an x-ray of the spinal canal following an injection of cotrast dye.

NOTE: view notes for images

Question 5

Management for Cauda Equina

Answer 5

• Emergency admission
• Immediate MRI scan
• Surgical decompression or surgical disectomy (for older patients) in theatre - within 48 hours are symptom onset- unless co-morbidities, or allergic to aesthetics

Prolapsed disc:
- Rest, NSAID, physio
- Lumbar nerve root injection-provides both diagnosis & treatment -epidural steroid injections
- If back pain >3 months surgery is considered but should be informed that back pain is rarely improved & only leg symptoms can be treated