Cauda Equina syndrome Flashcards Preview

Spine FRCS > Cauda Equina syndrome > Flashcards

Flashcards in Cauda Equina syndrome Deck (11):
1

What is cauda equina?

  • Defined by a consellation of symptoms that result from terminal spinal nerve root compression in the lumbosacral region
  • one true few medical emergencies

2

What are the key features of cauda equina?

  • Bilateral leg pain
  • Bladder and bowel dysfunction
  • Saddle anaesthesia
  • lower extremity sensorimotor changes

3

What is the epidemiology of cauda equina?

  • 1-6% lumbar disc herniations

4

What is the pathophysiology of cauda equina?

  • Space occupying lesions within lumbosacral canal  including
    • disc herniation- most common
    • spinal stenosis
    • tumours
    • trauma- retropulsion of fracture fragment
    • spinal epidural haematoma
    • epidural abscess

5

Name any associated conditions of cauda equina?

  • DVT
    • complx from spinal trauma/surgery

6

Can you describe the anatomy of the terminal spinal cord and nerve supply to the bladder?

  • Conus Medullaris
    • tapered, terminal end of spinal cord
    • T12/ L1 vertebral body
  • Filum Terminale
    • non neural, fibrous extension of conus medullaris that attaches to cocyx
    • compression-> LMN

Bladder

  • innervation from
  • parasympathetic- pelvic splanchnic/inf hypogastric
  • sympathetic-  hypogastric n's
  • external sphincter controlled by Pudendal nerve
  • LMN lesions of cauda equina will interupt nerve forming bladder arcs

7

What is the symptoms and signs of cauda equina?

Hx

  • acute ( dissc herniation) vs insidious ( tumour/spinal stenosis)

Symptoms

  • bilateral leg pain
  • sadddle anaethesia
  • Impotence
  • sensorimotor loss in lower extremity
  • neurogenic bladder dysfunction
    • disruption of bladder contraction & sensation-> urinary retention & then overflow

Signs

  • Inspection
    • lower leg muscle atrophy with insidious presentation- spinal stenosis
    • fascilations rare
  • Palpation
    • bladder - urinary retention
    • lower back- tenderness?
  • NV examination
    • bilat lower extremity weakness/sensory disturbance
    • decrease or absent  reflexes
  • Rectal exam
    • reduced /absent sensation to pinprick in perianal region (s2-4 dermatones)
    • Decreased rectal tone/voluntary contracture
    • diminished or asbent anal wink test /bulbocavernosus relfex

8

What investigations are useful in dx of cauda equina?

  • MRI
    • to evaluate neurological compression
  • Ct Myelogram for those with pacemakers

A image thumb
9

What is the tx of cauda equina?

Surgery

  • Urgent Surgical Decompression within 48hrs
    • sig suspicion of CES
    • severity of symptoms increase urgency of surgical decompression
  • Discectomy or Laminectomy
  • outcomes
    • improved outcomes in bladder/bowel fucntion and resolution of motor and sensory deficits when decompression preformed within 48 hrs of onset of symptoms

10

Describe the surgical approach to urgent decompression?

  • Posterior midline approach to spine
  • discectomy vs wide laminectomy and discectomy

A image thumb
11

What are the complications of delayed presenatation of CES or surgery on CES?

  • Sexual dysfunction
  • Urinary dysfunction requiring catherisation
  • chronic pain
  • Persistent leg weakness