Cauda Equina Syndrome
(CES; Compression of Spinal Nerve Roots; Syndrome, Cauda Equina; Spinal Nerve Roots, Compression)
Cauda equina syndrome (CES) is compression of the nerve roots at the base of the spinal cord. The nerve roots (known as the cauda equina, or "horse's tail") control the sensation and function of the bladder, bowel, sexual organs, and legs. It is rare.
Care may be needed right away to avoid long term damage.
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The most common cause is a herniated disc. Discs are semi-soft tissue between the bones (vertebrae) of the spine. The discs act as the spine’s shock absorbers. A disc that pushes into the spinal canal can press against the bundle of nerves and cause CES.
Other causes may be:
- Cancer that spreads from another part of the body
- Infection, such as meningitis
- Lumbar spinal stenosis—a narrowing of the spinal canal
- Blood clots or a buildup of blood that pushes on the spinal canal
- Inflammatory health problems, such as ankylosing spondylitis
- Trauma, such as from a car accident, gunshot, or knife wound
- Problems after surgery, spinal anesthesia, or spinal manipulation methods (less common)
Things that may raise the risk of this problem are:
CES may cause:
- Severe low back pain
- Problems passing or controlling urine or stool
- Numbness or tingling in the groin
- Weakness in the legs
- Problems walking, such as dragging a foot
- Not being able to keep an erection or other sexual problems
The doctor will ask about symptoms and health history. A physical exam will be done. The doctor will look for signs of nerve problems. A rectal exam may be done to check anal function.
Images may be taken of the spine and nearby structures. This can be done with:
Underlying causes will need to be treated. Emergency care may also be needed. Ways to do this are:
There are no known guidelines to prevent CES.
Surgery may be done to ease pressure on the nerves. Choices are:
Symptoms may be managed with medicines, such as:
- Pain relievers
- Vasodilators to widen blood vessels
- Steroids to ease swelling
Therapy may be needed to regain lost skills. Options are:
- Physical therapy—to help with movement
- Occupational therapy—to help with daily tasks and self care
- Incontinence care—to manage lost bladder control
- Bydon, M., Lin, J.A., et al. Time to surgery and outcomes in cauda equina syndrome: an analysis of 45 cases. World Neurosurg, 2016; 87: 110-115.
- Cauda equina syndrome. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/cauda-equina-syndrome.
- Cauda equina syndrome. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cauda-equina-syndrome.
- Rimas Lukas, MD
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