What Is Cauda Equina Syndrome?

Cauda Equina Syndrome is a condition when a group of nerve roots ( cauda equina ) experiences pressure at the bottom of the spinal cord. Nerve root functions as a liaison between the brain and the lower body organs, in receiving and send motor and sensory signals, from and to the legs, limbs and pelvic organs. When the nerve root is compressed, the signal will break and affect the function of certain body parts.

Cauda equina syndrome is a rare medical condition. If people with cauda equina syndrome are not immediately treated, this condition can cause permanent paralysis, urine and fecal incontinence, and sexual dysfunction. Sometimes, emergency handling is still not able to restore the patient's overall body function.

Causes of Cauda Equina Syndrome 
Cauda equina syndrome is caused by various conditions that result in inflammation or pinching of the nerves in the lower part of the spine. One condition that is the main cause of cauda equina syndrome is disc herniation or nucleus pulposus hernia. Discus herniation is a condition when the spinal pad is shifting. In addition, there are several conditions that can also cause cauda equina syndrome, namely:
  • Infection or inflammation of the spine
  • Spinal stenosis
  • Lower spinal cord injury
  • Birth defects
  • Venous artery malformation
  • Tumor in the spine
  • Spinal hemorrhage (subarachnoid, subdural, epidural)
Postoperative complications of the spine. 
In addition, there are several factors that increase a person's risk of developing cauda equina syndrome, namely:
  • Elderly
  • Athlete
  • Having excess weight or obesity
  • Often lifts or pushes heavy objects
  • Back injuries due to falls or accidents.
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Symptoms of Cauda Equina Syndrome 
Symptoms of cauda equina syndrome vary, develop gradually, and sometimes resemble the symptoms of other diseases, making it difficult to diagnose. Symptoms that can emerge include:
  • Great pain in the lower back
  • Pain along the pelvic nerve (sciatica), both in one or both limbs
  • Numbness in the groin area
  • Disorders of bowel movements and urination
  • Reduced or loss of lower limb reflexes
  • Weakened leg muscles.

Diagnosis of Cauda Equina Syndrome 
The doctor can suspect a patient has cauda equina syndrome if there are symptoms, which are strengthened by a physical examination. During a physical examination, the doctor will test the balance, strength, coordination, and reflexes in the patient's legs and feet. The doctor will instruct the patient to:
  • Sit
  • Stand up
  • Walk with heels and toes
  • Lift your legs in a lying position
  • Bend your body forward, back and side.
An imaging test is also performed to ensure the patient's diagnosis. Among others are:
  • Myelography, which is the procedure of examining the spine using X-rays and contrast fluid that is injected into the tissue around the spine. This examination can show the pressure that occurs in the spinal cord.
  • CT scan, to produce images of the condition of the spinal cord and surrounding tissue from various angles.
  • MRI, to produce detailed images of the spinal cord, nerve roots, and the area around the spine.
  • Electromyography, to evaluate and record electrical activity produced by muscles and nerve cells. Electromyographic results can see nerve and muscle dysfunction.

Cauda Equina Syndrome Treatment 
After the doctor confirms that the patient is diagnosed with cauda equina syndrome, then emergency treatment through surgery is necessary. Surgery aims to relieve the pressure that occurs at the spinal cord nerve. If cauda equina syndrome is caused by disc herniation, surgery can be performed on the spinal padding area to remove material that is pressing on the nerve.

Surgery should be carried out within 24 or 48 hours of the symptoms being felt. This action aims to prevent nerve damage and permanent disability.

Postoperative treatment will be performed on patients after undergoing surgery. Some treatments are carried out, namely:
  • Drug therapy. Doctors will provide several types of drugs to control or prevent other conditions that may be experienced by postoperative patients. Among others are:
    • Corticosteroids, to relieve postoperative inflammation
    • Pain relief, such as paracetamol, ibuprofen, to oxycodone, to relieve postoperative pain
    • Antibiotics, if cauda equina syndrome is caused by an infection
    • Medications to control bladder and intestinal function, such as tolterodine or hyoscyamine.
  • Radiotherapy or chemotherapy, as a follow-up treatment procedure if cauda equina syndrome is caused by a spinal tumor.
  • Physiotherapy. If cauda equina syndrome affects walking ability, the doctor will recommend patients to undergo physiotherapy. The medical rehabilitation doctor will plan a therapy program, which can help patients to restore leg strength to step.

Surgery does not directly restore overall body function. This condition depends on the level of nerve damage experienced by the patient. The function of the bladder and intestine takes several years to return to normal.

Prevention of Cauda Equina Syndrome 
Actions to prevent cauda equina syndrome are difficult, because the appearance of this syndrome often results from unpredictable injury or trauma. However, cauda equina syndrome caused by infection can be triggered by injecting drugs. Therefore, preventive measures that can be taken are by not using injecting drugs illegally.

Complications of Cauda Equina Syndrome 
If not treated immediately, cauda equina syndrome can cause several complications, namely:
  • Permanent paralysis. Depressed nerves can suffer permanent damage if left untreated, which will result in permanent paralysis, especially in the legs.
  • Inkotinensia urine and feces, occurs when the body loses control of urination (urine incontinence), or defecation (fecal incontinence). This condition is caused by nerves that do not function normally.
  • Sexual dysfunction. Cauda equina syndrome can also cause disruption of nerve function in the reproductive organs, especially men.

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