Cauda Equina

Question 1

What is CES?

Answer 1

Surgical emergency caused by compression of cauda equina

Question 2

What is the cauda equina?

Answer 2

Horse tail nerves at bottom of spinal cord

S2-4

Question 3

What are the cauda equina symptoms a combination of? (2 things)

Answer 3

Neuromuscular + urogenital symptoms

Question 4

What does the cauda equina nerve bundle supply? (3 things)

Answer 4

1. Motor and sensory innervation to lower limbs
2. Motor innervation to anal sphincters
3. Parasympathetic innervation of bladder

Question 5

What are the causes of cauda equina? (7 things)

Answer 5

Compresssion of cauda equina bc:

1. Disc herniation (most common)
2. Spinal stenosis (2nd common)
3. # / trauma
4. Cancer (thyroid / breast / lung / renal / prostate)
5. Infection
6. Congenital
7. Vascular

Question 6

What are some differential diagnosis of CES? (5 things)

Answer 6

1. Mechnical Back Pain
2. Guillain-Barré Syndrome
3. Lumbar Disc Disorders
4. Cancer
5. Spinal Cord Infections / injuries

Question 7

What are the clinical features of CES? (9 things)

Answer 7

1. Back pain
2. Bladder / bowel dysfunction
3. Urinary retention
4. Erectile dysf
5. Loss of sexual sensation
6. Loss of anal tone
7. Reduced leg sensation
8. Leg motor weakness
9. Hypoflexia

Question 8

What clinical feature should you make sure you check for in CES?

Why?

Answer 8

Bladder dysf (esp for retention)

• Confirmed retention = complete CES
• Reduced ability to void (loss of desire / sensation) = incomplete CES

Question 9

What should you check for in examination of sus CES? (2 things)

Answer 9

1. PR exam

2. Post-void bladder scan

Question 10

What are the 3 classifications of CES?

Answer 10

1. CES w Retention (CESR)
2. Incomplete CES (CESI)
3. Sus CES (CESS)

Question 11

What are the characteristics of CESR? (2 things)

Answer 11

1. Complete retention

2. Overflow incontinence

Question 12

What are the characteristics of CESI? (2 things)

Answer 12

1. Loss of desire to void
2. Less sensation
3. Poor stream
4. Need to strain

Question 13

What is the gold standard investigation for CES?

Answer 13

MRI

Question 14

What are the management options for CES? (4 things)

Answer 14

1. Urgent surgical decompression
2. High dose steroids (dexamethasone) – reduce localised swelling
3. Immobilisation if trauma
4. Chemo/ radiotherapy if malignancy