L-Spine

Cauda Equina Syndrome

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Cauda Equina Syndrome, Epidural Compression Syndrome

  • See Also
  1. Lumbar Stenosis
  • Pathophysiology
  1. Massive Central DIsc protrusion
  2. Compression of lumbar spinal nerve roots
  • Causes
  1. Large Central DIsc Herniation
  2. Lumbar Spinal Stenosis
  3. Lumbar Spondylosis with cauda equina compression
  4. Post-procedure (iatrogenic)
    1. Epidural Hematoma
    2. Epidural Abscess
  • Symptoms
  1. Bilateral Sciatica
    1. See also Lumbar Stenosis for extensive description
    2. Dull aching pain in perineum, Bladder or Sacrum
    3. Radiation to Buttock and leg
    4. Provoked by Exercise or prolonged standing
    5. Relieved with rest or forward bending
  2. Neurologic Changes
    1. Saddle anesthesia
    2. Bowel or bladder Incontinence
    3. Acute Urinary Retention
  • Signs
  1. Loss of perineal sensation or perineal reflex
  2. Foot drop
    1. Ankle dorsiflexion bilateral weakness
    2. Absent Ankle Jerk
  • Imaging (See Lumbar Stenosis)
  1. L-Spine MRI (preferred)
  2. CT Myelography
    1. Indicated if MRI contraindicated
  • Lab (Indicated if Epidural Abscess or other infection suspected)
  1. Complete Blood Count
  2. Erythrocyte Sedimentation Rate (ESR)
  3. C-Reactive Protein (CRP)
  • Diagnosis
  • High yield exam findings
  1. Altered perineal sensation
  2. Abnormal rectal tone
  3. Increased post-void residual
  • Management
  1. Neurologic Deficits suggest Cauda Equina Syndrome
  2. Immediate Neurosurgery Consultation
  • Prognosis
  1. Delay >72 hours risks permanent neurologic deficit