Cauda equina syndrome

TL;DR

Cauda Equina Syndrome (CES) is a critical neurological disorder resulting from the compression or damage to the cauda equina nerve roots in the spinal canal. It manifests through symptoms such as lower extremity weakness, urinary and faecal incontinence, sexual dysfunction, and saddle anaesthesia. CES is considered a medical emergency, with treatments often involving surgery to relieve pressure on the nerves. Early detection is crucial for a better prognosis, highlighting the importance of awareness and timely medical intervention.

Cauda equina syndrome (CES) is a neurological condition characterised by a sudden loss of function of the lumbar plexus – the nerve roots of the spinal canal in the spinal cord – usually due to compression, trauma or other damage to the area.

The spinal canal contains a mass of nerves (the cauda equina which means ‘horse tail’) that branches off at the lower end of the spinal cord and houses the nerve roots from L1-5 and S1-5.

The nerve roots from L4-S4 connect in the sacral plexus, affecting the sciatic nerve as it heads to the feet.

Causes of cauda equina syndrome

Cauda equina syndrome can be caused by a slipped disc, fractures, wounds (knife, bullets), or tumours or other lesions that upset the function of the nerves.

A bad lumbar puncture, trauma created by catheters, or high doses of anaesthetics in the area can also trigger CES. Lumbar spinal stenosis can also cause CES, with the spinal canal narrowing, often due to osteoarthritis or other degenerative diseases, or in fact an anatomical abnormality.

The most severe case of CES is called spondylolisthesis cauda equina syndrome, and can result in death. Chronic spinal inflammation may be a cause, including Paget’s disease, ankylosing spondylitis, tuberculosis, or polyneuropathy.

It can also occur during pregnancy due to lumbar disc herniation, with age of the mother increasing the risk. Surgery can be performed on pregnant women.

Signs and symptoms of cauda equina syndrome

  • The lower extremities may become weak
  • Lower extremities may become paralysed
  • Smooth muscle of the bladder (detrusor) may become weak, causing urinary retention and post-void residual incontinence
  • Loss of anal tone and faecal incontinence
  • Sexual dysfunction
  • Saddle anaesthesia (numbness)
  • Leg pain
  • Leg weakness
  • Lack of ankle reflexes
  • Usually there is no pain and the person can walk

Treatment of cauda equina syndrome

Treatments usually include surgery to decompress the spine and remove problematic bone, tumours or blood, depending on the cause.

CES is considered a medical emergency, because if not treated quickly, long-term damage to nerves can occur. Steroids may be used. Physiotherapy may be required.

Outcomes of cauda equina syndrome

Typically a complete recovery is seen, but this depends on many factors. Severity and duration of nerve compression matters a lot when it comes to outcomes, so the longer time the nerve was compressed, the worse the outcome.

Nerve regrowth may be impossible at certain stages of damage. Nerves take a very long time to grow, so recovery may be years.

Early detection can significantly improve outcomes, with early signs being changes in the bowel and bladder, and a loss of sensation in the groin area.



Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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