Understand Cauda Equina Syndrome
and the Red Flags to Look For

Cauda equina syndrome is a very serious condition that requires
immediate action to avoid permanent impairment or disability.






"learning the symptoms, causes, and treatments"

Anytime you or a loved one have, or think you might have, cauda equina syndrome. Educating yourself and learning the symptoms, causes, and treatments is the first step in knowing what to do next. The cauda equina is the tail end of the spinal cord. Cauda equina is Latin for "horse's tail" because the appearance of the cauda equina is very similar to a horse's tail. 

The spinal cord extends down from the brain through the cervical and thoracic spinal canal. In the lower thoracic spine the spinal cord tapers down to form the conus medullaris.

"nerve roots that comprise the cauda equina"

Then at the level of the L1 vertebra, the conus medullaris, divides into the innumerable nerve roots that comprise the cauda equina.

These many nerve roots are floating in cerebrospinal fluid, which is the same fluid that surrounds the brain. As they go down the spinal canal each nerve exits at the appropriate level between the vertebra.

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"nerve roots are floating in cerebrospinal fluid"

The thecal sac is a tube shaped structure around the outside of the nerves that contains the fluid. The thecal sac is composed of two layers, the arachnoid, and the dura mater.

"These nerves are also responsible for..."

After these nerve roots leave the spinal canal they go to every part of your body below the waist. These are the nerves that control your bowels and bladder and the muscles in your lower body and legs. These nerves are also responsible for sensation in your lower extremities and the function of organs in your lower body.

"with its flow of oxygen and nutrients"

The exact cause of this syndrome is unclear but is seems to occur from any injury to one of the nerves of the cauda equina. It appears to occur from inflammation, or when a nerve is pinched or loses its blood supply, with its flow of oxygen and nutrients.

When the nerve is being pinched with enough pressure it ceases to function properly. The exact symptoms will depend on what is injuring the nerve and where the injury is occurring.

If the pressure on the nerve is not quickly and effectively relieved, and the blood flow restored, the nerve will die from lack of oxygen. This can result in permanent dysfunction of whatever that nerve controlled. 

"develop in association with back pain"

The symptoms normally develop in association with back pain, sciatica, and other lower extremity pain. When you are having low back pain or sciatica you need to be alert for the symptoms of this syndrome

The Symptoms of Cauda Equina Syndrome:

  • Difficulty controlling your bowels and bladder
  • Progressive lower extremity weakness

If you're having low back pain or sciatica, when these symptoms occur, you need to be seen by a doctor immediately. Have someone take you to the emergency room or call an ambulance.

"If you have any sudden changes..."

As we age, many times there is a gradual decrease in our ability to hold our urine. We may leak a little when we cough or sneeze, but this develops gradually.

If you have any sudden changes you may need to see your doctor.

This syndrome can cause urinary retention, which means you can't into your bladder, or it can cause urinary incontinence which means you can control when you go.

"you cannot control your bowels"

This can also cause problems controlling your bowel movements. If you suddenly find that you cannot control your bowels, and are soiling your pants, you need to see your doctor because you may be developing a serious problem.

Progressive weakness in your lower extremities is another symptom of this syndrome. As time passes and the years go by, it is normal for us to lose strength, but this happens gradually. If you notice any sudden change in the muscle strength of your legs this may be a sign of cauda equina syndrome. 

"pressure on the nerves"

Conditions that can put pressure on the nerves and cause cauda equina syndrome would include traumatic injury,spinal stenosis, herniated disk, and tumors or other growths within the spinal canal.

  Human Cauda Equina

       Image thanks to John Beal PhD via Wikimedia Commons

An injury from a fall, a motor vehicle accident, or other calamity can cause fractures or other damage to the spine. If a nerve is being pinched you may develop cauda equina syndrome and require immediate attention.

"a gradual narrowing of the space for the nerves"

Spinal stenosis is a gradual narrowing of the space for the nerves. It develops over years and can put pressure on nerves causing pain and numbness and other problems. Spinal stenosis can cause cauda equina syndrome when the pressure on the nerve becomes sufficient to stop its blood supply.

And herniated disk can occur when the outer ring of the disc weakens and ruptures, allowing the soft inner part of the desk to push out into the space for the nerves. If this pushes on nerve in such a way as to block its blood supply this can cause cauda equina syndrome.

"chronic inflammatory conditions"

Tumors or any abnormal growths within the spinal canal can put pressure on the nerves when they reach sufficient size. If the pressure becomes strong enough to block blood supply to the nerve you can develop cauda equina syndrome.

Long-term chronic inflammatory conditions, such as ankylosing spondylitis or Paget's disease, can cause this syndrome possibly from swelling and irritation from the inflammatory factors.

"remove the pressure from the nerves immediately"

There are different ways of treating cauda equina syndrome but the most important thing is to remove the pressure from the nerves immediately. In most cases this is best accomplished with surgery.

The surgeon can go in, and remove whatever is pressing on the nerve, allowing the nerve to regain its blood flow. Hopefully this can be done before the nerve dies.

When this condition is caused by an inflammatory condition, corticosteroids may be used, to reduce the swelling and relieve the inflammation. 

"most people can return to normal lives"

When surgery can be performed or other treatments given, before the nerve dies or otherwise ceases to function, most people can return to normal lives. But, if the nerve sustains a permanent injury, before it can be treated, there may be permanent impairment or loss of function.

If you're having low back pain or sciatica and begin developing any of these symptoms you must be seen by doctor immediately. Cauda equina syndrome is an emergency that requires immediate treatment to avoid permanent injury.



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