Cauda equina syndrome (CES) and Cauda medulla syndrome (CMS) are neuromuscular andurogenital conditions caused by the pressing of lumbosacral nerve roots. CES compresses nerves below the level of the conus medullaris, typically at the L3-L5 vertebrae, and CMS compresses the nerves fromT12 to L2 vertebrae in the lower thoracic and upper lumbar area. Both syndromes have overlappinganatomy; consequently, patients present to the clinic with the same symptoms. According to Dawodu (2018), “the spinal cord tapers and ends at the first and second lumbar vertebrae in an average adult.The most distal bulbous part of the spinal cord is called the conus medullaris, and its tapering endcontinues as the filum terminales. Distal to the end of the spinal cord is a collection of nerve roots,which are horsetail-like in appearance and hence called the cauda equina (Latin for Horse tail)”(Paragraph 1). The compression of the nerves can be caused in a number of ways: spinal stenosis, discherniations, intradural disc rupture, spinal stenosis secondary to other conditions, traumatic injuries,tumors, infections, arteriovenous malformation or hemorrhage, and iatrogenic injuries.
Patients may experience symptoms such as pain, numbness, and weakness in the lower back, pelvis, and legs. Some people may experience foot drop, loss of bowel and bladder control, sexual dysfunction, and paralysis. A medical emergency can result depending on the severity of these symptoms. People experiencing any of these symptoms should seek a consultation with a neurologist orneurosurgeon for an assessment that requires a magnetic resonance image (MRI) of the lumbar spine and a myelogram to assess damage to the spinal cord.
The best treatment for CES is to fix the underlying cause. This requires removing the cause of the compressed nerves to prevent permanent neurological damage. Symptoms are likely to improve during post-surgical recovery; however, some patients may have permanent neurological damage, chronic pain, and mental health issues related to the impact of the chronic conditions on the irrelationships and life. Therefore, a psychiatric consult may also be necessary. Cauda Equina steroid injections, administered by a pain management specialist, will only provide temporary relief and may have multiple side effects, such as high blood pressure, diabetes, and osteoporosis, due to long-termsteroid use.
References
American Association of Neurological Surgeons. (2020). Cauda Equina Syndrome. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cauda-Equina-Syndrome
Dawodu, S.T. (2018). Cauda Equina and Conus Medullaris Syndromes. https://emedicine.medscape.com/article/1148690-overview#a5
NIH. (2020). Cauda Equina Syndrome. https://rarediseases.info.nih.gov/diseases/10987/cauda-equina-syndrome
Yok_onepiece. (2020). [MRI Image]. A lateral projection of lumbar spine x-ray showing degenerativespondylolisthesis at L5/S1 level that causes low back pain and sciatica. https://www.shutterstock.com/image-photo/lateral-projection-lumbar-spine-xray-showing-1774387022