Cauda equina syndrome

Cauda equina syndrome


Learning medicine is hard work! Osmosis makes it easy. It takes your lectures and notes to create
a personalized study plan with exclusive videos, practice questions and flashcards, and so
much more. Try it free today! Cauda equina syndrome is a condition caused
by damage to the bundle of peripheral nerves protruding from the bottom of the spinal cord,
called the cauda equina. The latin words cauda equina mean horse’s
tail, which is what early anatomists thought this nerve bundle looked like. The spinal column is made of individual bones,
called vertebrae. Each vertebra is made of a large anterior
portion called the body, and the posterior part called the vertebral arch. The central cavity between the body and the
arch is called the vertebral foramen. Now the spinal column is made of 33 vertebrae:
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. Each cervical, thoracic, and lumbar vertebra
is separated by an intervertebral disc, which allows for a slight movement of the vertebrae,
and act as a shock absorber. The sacral and coccygeal vertebrae are fused
together to form the sacral bone and coccyx, or tailbone respectively. Now if you cut the spinal column in half lengthwise
you can see that all the vertebral foramina together form the vertebral, or the spinal
canal, which is occupied by the spinal cord. The spinal cord is connected to the brain
and travels through the spinal canal to the second lumbar vertebra, where it ends in a
cone, called conus medullaris. There are 31 pairs of nerves originating from
the spinal cord called spinal nerves; there are 8 cervical, 12 thoracic, 5 lumbar, 5 sacral
and 1 coccygeal. Each nerve leaves the spinal canal through
the corresponding intervertebral foramen, which are openings between two adjacent vertebrae. Since the spinal cord is shorter than the
spinal canal, the nerves of the lumbar, sacral and coccygeal regions have to travel down
the spinal canal to reach their corresponding openings, forming a nerve bundle below the
spinal cord called the cauda equina. These nerves carry motor innervation for the
genitals, both internal and external anal sphincter, detrusor vesicae, which is a muscle
in the bladder that contracts during urination, and muscles of the leg. They are in charge of the knee and ankle reflexes. Skin sensations of the legs and pelvis are
also carried by these nerves. Cauda equina syndrome is caused by compression,
trauma, or damage to multiple nerves of the cauda equina. Large lumbar disc herniation is the most common
cause of cauda equina syndrome. And poor posture, traumas, physical activity,
and strong rotational movement can cause herniations where the intervertebral disc bulges out and
compress the nerves or spinal cord. This is similar to sciatica, but the herination
is usually larger, and more nerves are compressed, including those that control the bladder and
reproductive organs. Compression can also be caused by spinal stenosis
which is the narrowing of the vertebral foramen in the lumbar vertebrae. It can be congenital, meaning that the person
is born with it, or acquired, usually due to degenerative disorders like ankylosing
spondylitis, where the bones remodel causing intervertebral discs ossification, and the
narrowing of the spinal canal. Another cause is spondylolisthesis where a
lumbar vertebrae is displaced. This can be caused by trauma, surgery or degenerative
spinal disease. The most common type of lumbar spondylolisthesis
is anterolisthesis, where a vertebra moves forward and narrows the spinal canal, causing
compression of the nerves. Finally, any trauma to the spine, like the
one caused by a car crash, gunshot, etc. can lead to nerve damage or compression directly,
or by causing bleeding inside the spinal canal, causing compression via hematomas. Finally any growths within the spinal canal
like tumors, cysts, or abscesses can cause compression on the spinal cord and nerves. Symptoms of cauda equina include decreased
bowel and bladder control due to a decreased tone of anal sphincters and muscle wall of
the bladder and decreased sexual function. It can also cause saddle anesthesia, which
is a loss of sensation in the saddle area, which includes the buttocks, inner surface
of the thigh and perineum. One or both legs can be impaired by muscle
weakness, loss of knee and ankle reflexes, and even paraplegia, which is when the affected
person loses all feeling and muscle control in the legs. Sometimes, there can be sciatic pain, which
is a sharp pain going down the back and leg. Diagnosis of cauda equina syndrome is usually
based on the pattern of sensory and motor nerve findings and confirmed by an MRI or
CT scan. The treatment of cauda equina syndrome depends
on the cause. If it was caused by disc herniation, trauma,
tumors or abscess, the symptoms appeared suddenly, and surgical decompression should be performed
within 48 hours. Abscesses should also be treated with antibiotics. However if it’s caused by degenerative disease,
then symptoms appear more gradually, and it’s treated with anti-inflammatory medications
and corticosteroids. All right, as a quick recap cauda equina syndrome
is a condition caused by damage or compression to the nerves or cauda equina. The most common cause is lumbar disc herniation. Typical symptoms include decreased urinary
and bowel control, decreased sexual function, and saddle anesthesia. Depending on the cause cauda equina syndrome
can be treated surgically, as well as by anti-inflammatory medications or by antibiotics.

25 Comments

Leave a Reply

Your email address will not be published. Required fields are marked *