Cauda Equina

Question 1

Defintion

Answer 1

Neurological emergency: spinal cord compression of lumbosaral nerve roots that extend below the spinal cord
- usually presents with lower motor neurone signs (e.g. hyporeflexia + hypotonia)

Question 2

Causes

Answer 2

• Central disc prolapse (L4/5 or L5/S1) - MC
• Tumours
• Infection: abscess, discitis
• Trauma
• Haematoma
• Lumbar spinal stenosis: narrowing of the spinal cord may result in CES. Some causes include spinal osteoarthritis (spondylosis), rheumatoid arthritis, and a slipped vertebra (spondylolisthesis)

Question 3

Signs

Answer 3

• Lower back pain
• Bilateral sciatica
• Decreased or absent lower limb reflexes
• SADDLE ANAESTHESIA: Reduced Perianal sensation (S2-S4) and anal tone
• Bladder dysfunction + sphincter involvement
• Palpable bladder due to urinary retention
• Erectile dysfunction

Question 4

Investigations

Answer 4

GOLD STANDARD: MRI spine: must be requested urgently
- Bladder ultrasound: to determine whether urinary retention is present; do not delay an MRI to do a bladder scan if there is a high clinical suspicion of CES

Question 5

Management

Answer 5

• Emergency decompressive laminectomy: surgery should be performed within 24-48 hours of symptom onset
• Corticosteroids or radiotherapy: may be considered in certain patients with CES secondary to malignancy, although optimal management remains controversial