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Cauda Equina Syndrome

(CES; Compression of Spinal Nerve Roots; Syndrome, Cauda Equina; Spinal Nerve Roots, Compression)

Definition

Cauda equina syndrome (CES) is compression of the nerve roots at the base of the spinal cord. The nerve roots (known as the cauda equina) are responsible for the sensation and function of the bladder, bowel, sexual organs, and legs. CES is a medical emergency. If treatment is not started to relieve pressure on the nerves, function below the waist may be lost.
Cauda Equina
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Causes

A common cause of CES is injury of a spinal disc on the nerve roots. A spinal disc is a semi-soft mass of tissue between the bones of the spine. These bones are known as the vertebrae. The discs act as the spine’s shock absorbers. When a disc spills out into the spinal canal, it can press against the bundle of nerves, causing CES. This syndrome may also be caused by:

Risk Factors

Factors that may increase your risk of CES include:

Symptoms

CES may cause:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. A neurological exam, which includes testing reflexes, vision, mental status, and strength, may also be done. A rectal exam may be done to assess anal sphincter function.
Imaging tests evaluate the spine and nearby structures. These may include:
Your muscle activity may be measured. This can be done with electromyography (EMG).

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Your doctor may also treat the underlying cause of CES.

Follow-up Care

The long-term effects of CES can range from mild to severe. Problems may include:
  • Difficulty walking
  • Problems with bladder and bowels
  • Sexual dysfunction
  • Paralysis
Your follow-up care may involve working with a:
  • Physical therapist
  • Occupational therapist
  • Neurologist—doctor who specializes in the nervous system
  • Incontinence specialist—if you have lost bladder control

Medication

Your doctor may prescribe medication for:
  • Pain
  • Bladder and bowel difficulties

Prevention

There are no current guidelines to prevent CES.

RESOURCES

Cauda Equina Syndrome Resource Center http://www.caudaequina.org

United Spinal Association http://www.spinalcord.org

CANADIAN RESOURCES

Canadian Spinal Research Organization http://www.csro.com

Spinal Cord Injury Canada http://sci-can.ca

References

Cauda equina syndrome. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00362. Updated March 2014. Accessed November 20, 2014.

Cauda equina syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 20, 2014. Accessed November 20, 2014.

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