Cauda Equina Syndrome

The spinal cord only reaches to the L1 level in most people. The Cauda equina is the continuation of the nerves given off from the lower spinal cord destined
for the lower limb and pelvis.

The term comes from the Latin for “horse’s tail”!  The cauda equina syndrome refers to the compression of those nerves, affecting movement and sensation
in your lower body.

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What is Cauda Equina syndrome?

Cauda equina syndrome is a rare condition involving compression of the lower spinal nerve roots in the lumbar canal known as the cauda equina.

This leash of nerves sits at the lower end of your spinal canal and looks a bit like a horse’s tail (which is the meaning of ‘cauda equina’ in Latin).

The nerves in the cauda equina send messages to your pelvic organs, legs and feet. Cauda equina syndrome happens when those nerves are severely compressed and can no longer communicate easily with your lower body. It’s a serious condition that needs urgent surgical treatment.

What causes Cauda Equina syndrome?

Cauda equina syndrome is caused by a severe compression of your cauda equina.

Many things can cause that compression including: 

• Massive disc prolapse,
• Spinal tumours or lesions
• Spinal haemorrhage
• Significant burst fractures or dislocation of the lumbar spine
• Spinal infection or inflammation
• Spinal stenosis (a narrowing of the spinal canal) in the lower back

Very occasionally, cauda equina syndrome can result from complications after previous surgery on your lower back such as a postoperative haematoma.

Who gets Cauda Equina syndrome?

Anyone can develop this condition. Cauda equina affects men and women of all races.

Adults may develop cauda equina syndrome due to a prolapsed disc or age-related degeneration in the spine. Both children and adults may develop cauda equina after a severe injury to the spine when the vertebrae is fractured into the neural canal.

One of the most common reasons is if you have had cancer elsewhere, it may metastasize to the spine and then grow into the canal and compress the nerve roots. Sometimes it may be the first presentation of underlying cancer.

What are the signs and symptoms of Cauda Equina syndrome?

Regardless of the cause, the key signs and symptoms of cauda equina syndrome are:

• Severe back pain
• Severe pain in both legs (sciatica)
• Numbness and weakness in the lower back and legs
• Loss of bladder and bowel control
• Numbness in the bottom and perineum (the crotch area around your vagina or scrotum).

These symptoms (particularly numbness and incontinence) should always be investigated quickly through an urgent appointment with your GP or at your local emergency department.

But rest assured, cauda equina syndrome is rare. It is expected that in one year only one person per 100, 000 will develop the condition.

How is Cauda Equina syndrome diagnosed?

Cauda equina syndrome is usually diagnosed based on imaging tests, including:

• Magnetic resonance imaging (MRI) of the spinal cord and nerve roots is the usual investigation that will demonstrate most clearly if it is present and the underlying cause
• A CT +/-  myelogram is another option if MRI is not available which can show if the cauda equina is compressed

What’s the treatment for Cauda Equina syndrome?

Cauda equina syndrome is treated through emergency surgery to relieve pressure on the nerves. The exact type of surgery will depend on the underlying condition that’s compressing your cauda equina.

What’s the outlook after Cauda Equina syndrome?

With timely diagnosis and surgery, normal function can often be restored.

However, if there’s a significant delay before decompression surgery happens, cauda equina syndrome can cause permanent damage to the nerves that control your lower body. That can lead to incontinence, leg weakness and numbness, and sexual dysfunction. 

How can The Victorian Orthopaedic Spine Service help?

Our surgeon, Dr David Edis, is an experienced orthopaedic surgeon who has performed many decompression surgeries in over 20 years of practice. He regularly participates in the spinal on call roster for Mulgrave Private and Peninsula Private hospitals.

However, if you have symptoms of cauda equina syndrome, your first step is to see a doctor at your nearest emergency department for an urgent assessment. They can refer you on to our service.

Disclaimer

All information is general in nature. Patients should consider their own personal circumstances and seek a second opinion. Any surgical or invasive procedure carries risks.