II. Pathophysiology

  1. Massive Central DIsc protrusion
  2. Compression of lumbar spinal nerve roots

III. Precautions

  1. Maintain a high index of suspicion
  2. Delayed diagnosis or misdiagnosis is not uncommon (even by neurosurgical senior residents)
    1. Bell (2007) Br J Neurosurg 21(2): 201-3 [PubMed]

IV. Causes

V. 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 Incontinence
    3. Bladder Incontinence or Acute Urinary Retention

VI. Signs

  1. Loss of perineal Sensation or perineal reflex
    1. May best correlate with cauda equina findings on MRI
  2. Loss of rectal tone
  3. Increased post-void residual Urine Volume
  4. Foot Drop
    1. Ankle dorsiflexion bilateral weakness
    2. Absent Ankle Jerk

VII. Imaging (See Lumbar Stenosis)

  1. L-Spine MRI (preferred)
  2. CT Myelography
    1. Indicated if MRI contraindicated

VIII. Lab (Indicated if Epidural Abscess or other infection suspected)

IX. Diagnosis: High yield exam findings

  1. Altered perineal Sensation
  2. Abnormal rectal tone
  3. Increased post-void residual

X. Management

  1. Neurologic Deficits suggest Cauda Equina Syndrome
  2. Immediate Neurosurgery Consultation

XI. Prognosis

  1. Delay >72 hours risks permanent neurologic deficit

XII. References

  1. Cali and Bond (2022) Crit Dec Emerg Med 36(7): 4-11
  2. Balasubramanian (2010) Br J Neurosurg 24(4): 383-6 [PubMed]

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Ontology: Cauda Equina Syndrome (C0392548)

Definition (NCI) A rare neurologic disorder caused by impingement of the nerve roots of the cauda equina secondary to disc herniation, spinal stenosis, vertebral fracture, neoplasm or infection. Clinical signs may include bladder or bowel dysfunction, paresthesia and weakness of the lower extremities. The clinical course rapidly deteriorates and necessitates emergent surgical decompression to minimize risk of incontinence, sexual dysfunction and permanent paralysis.
Concepts Disease or Syndrome (T047)
MSH D011128
ICD9 344.6
ICD10 G83.4
SnomedCT 192973005, 89356000, 192972000, 155032006, 192970008
English Cauda equina syndrome NOS, cauda equina syndrome, cauda equina syndrome (diagnosis), Cauda Equina Syndromes, Syndrome, Cauda Equina, Syndromes, Cauda Equina, lumbosacral syndrome, syndrome cauda equina, Cauda equina syndrome NOS (disorder), Lumbosacral syndrome, Polyneuritis equi, Cauda equina neuritis, Cauda equina syndrome, Cauda equina syndrome (disorder), cauda equina; syndrome, syndrome; cauda equina, Cauda equina syndrome, NOS, Cauda equina syndrome (disorder) [Ambiguous], Cauda Equina Syndrome
Italian Cauda Equina, Sindrome lombo-sacrale
Dutch lumbosacraal syndroom, cauda equina; syndroom, syndroom; cauda equina, cauda equina syndroom, Cauda-equinasyndroom
French Syndrome lombosacré, Syndrome de la queue de cheval
German Lumbosakralsyndrom, Cauda-equina-Syndrom, Cauda- (equina-) Syndrom, Cauda equina Syndrome
Portuguese Síndrome lombossagrada, Síndrome da Cauda Equina, Síndrome da cauda equina
Spanish Síndrome lumbosacro, Síndrome de Cauda Equina, síndrome de la cola de caballo, SAI (trastorno), síndrome de la cola de caballo, SAI, síndrome de la cauda equina, SAI, síndrome de la cauda equina, síndrome de la cola de caballo (concepto no activo), síndrome de la cola de caballo (trastorno), síndrome de la cola de caballo, Síndrome de cauda equina
Japanese 馬尾症候群, 腰仙部症候群, ヨウセンブショウコウグン, バビショウコウグン
Czech Syndrom cauda equina, Lumbosakrální syndrom, syndroma caudae equinae, syndrom caudae equinae, syndrom kaudy
Korean 말총증후군
Hungarian Cauda equina syndroma, Lumbosacralis syndroma
Norwegian Cauda equina-syndrom