Cauda Equina Syndrome

Exam Cram

Background

• Syndrome where the spinal nerves are compressed, particular the nerves responsible for urinary and faecal continence

• Emergency surgery is indicated to save these nerves- this is commonly missed and one of the largest sources of compensation in NHS

• Presentation: progressive lower back pain with bilateral leg weakness, areflexia, saddle parasthesia, reduced anal tone

Outline

Background

• Spinal column (UMN) terminates at L1/2, below which each nerve forms a bundle of LMN from L2 towards C1

• Cauda equina = horses tail, referring to the tail like structure of nerves post termination of the spinal column

• These nerves can become compressed, producing a poly LMN radiculopathy, of note damaging the nerve supply for urinary and faecal incontinence

• This damage can be reversed if emergency surgery is offered before the nerve dies

Conus Medullaris Syndrome

• Presentation: acute sudden lower back pain

• O/E: reduced ankle reflexes, preserved knee reflexes

Pain is more acute but not always more painful