Definition
Cauda equina syndrome is a severe neurological condition characterized by acute loss of lumbar plexus function, which provides sensory and motor innervation of the lower abdomen and lower limb, from the groin to the medial malleolus. This phenomenon results from a lesion of the terminal roots of the spinal cord, which emerge below L1-L2.
Cauda equina syndrome is frequently caused by compression of nerve roots, secondary to the protrusion of a disk hernia of the lumbar spine or to the presence of neoplastic processes.
Alterations in the functionality of the cauda equina can also derive from direct traumatisms, arteriovenous malformations, chronic inflammatory diseases (eg Paget's disease and ankylosing spondylitis) and lumbar spinal stenosis due to degenerative processes (as in the case of arthrosis ) or present from birth.
Most common symptoms and signs *
- Alve alterations
- Erectile dysfunction
- Bladder dysfunction
- Groin pain
- Tingling in the legs
- Sore legs
- Fecal incontinence
- Hypoaesthesia
- weakness
- Backache
- Paraplegia
- Paresthesia
- Urinary retention
- Sciatica
- Spinal stenosis
Further indications
Based on the extent of the damage and the nerve roots involved, the cauda equina syndrome can involve low back pain and / or sciatica, motor weakness or loss of sensitivity in the lower limbs.
Clinical manifestations may also include inguinal and perineal pain, difficulty initiating urination, erectile dysfunction and loss of the anal sphincter with fecal incontinence. In severe forms, cauda equina syndrome may involve sellar anesthesia (loss of sensation in the sacral, anal, perineal, and genital region), urinary retention, or neurogenic bladder with incontinence.
Diagnosis is usually confirmed by computerized axial tomography or nuclear magnetic resonance.
Treatment depends on the aetiology of the syndrome and may include surgical decompression (within 48 hours of symptom onset), use of NSAIDs and corticosteroids, rest and physiotherapy.
In any case, it is necessary to increase the probability of recovery of bladder and bowel function and reduce further weakness in the lower limbs. If not properly treated, cauda equina syndrome can cause permanent paraplegia.
