Cauda equina syndrome is an emergency that needs to be treated as soon as possible. It is a form of spinal nerve compression, but if left untreated, it can lead to permanent paralysis of one or both legs and permanent loss of bowel/bladder control. Lower back pain after sitting for too long or improperly lifting something heavy happens to most if not all of us.

However, sometimes pain in the lower back can be an indicator of something more serious. Especially, for individuals that are dealing with or managing back pain. One condition is cauda equina syndrome. It’s not like sciatica or arthritis, but it does have specific symptoms that individuals should be aware of.

Cauda Equina Syndrome

The term comes from Latin that means horse’s tail. The cauda equina forms the group of nerves that run through the lumbar spinal canal. Generally, the condition means two things:

• There is nerve compression of most of the lumbar spinal canal
• Compression symptoms like numbness or weakness in the leg/s

How cauda equina syndrome differs from typical compression of the lumbar spinal canal is that it can be caused by different issues, from fractures, tumors, and infections. More commonly, it is disc herniations that cause the problems. The key difference is the degree of nerve compression, and the number of nerves compressed.

For example, compression of a single nerve will not cause loss of bladder function. But compression of multiple nerves, especially the sacral nerves can cause loss of function. Nerve compression that leads to pain or numbness can be treated differently. Surgery is reserved for severe cases and for individuals that are not improving with non-invasive treatment.

Sneaky Presentation

One of the major factors is long-term compression that individuals do not realize they have. Individuals are more likely to be aware of symptoms from another spinal condition before cauda equina syndrome presents. However, the condition presents quickly but often other overlapping back problems mask cauda equina syndrome.

Causes

The syndrome can be brought on from anything that compresses the nerves. Most commonly, it is a root compression from degenerative processes, specifically lumbar disc herniations. Other causes include:

• Bleeding like an epidural hematoma
• Trauma like fractures or penetrating trauma
• Tumors growing in the canal or the collapse of a tumor-affected bone
• Disc herniations can progressively grow in size, which leads to a slowly-evolving cauda equina syndrome.
• An enlarging disc herniation or synovial cyst can further compromise the already compressed nerves.
• Overgrowth of arthritic joints or bone spurs into the spinal canal can lead to long-term compression.

Symptoms

The symptoms vary based on the degree that the spinal canal has been affected:

• Back pain
• Leg pain
• Sciatica
• Saddle numbness that extends into other areas of the legs
• Neurogenic bladder dysfunction. This can range from difficulty starting to urinate or limited and/or non-voluntary control urinating.
• Bowel dysfunction
• Sexual dysfunction

Diagnosis

A doctor will examine any significant changes in bladder, bowel, or leg function that are considered red flags prompting an early and complete assessment. A physician will ask for a complete/detailed history of the onset and progression of symptoms.

The second is a close physical examination which includes testing sensation and strength along with a rectal exam to assess voluntary contraction. Also checking the body’s reflexes, assess walking gait and alignment. If most or all of the symptoms are presenting this will set in motion spinal imaging or an MRI. If the symptoms, exam, and imaging match, it will lead to an emergency admission to the hospital.

Body Composition Spotlight

Obesity and Osteoarthritis Connection

A variety of factors contribute to the development of osteoarthritis, including genetic factors and lifestyle choices. Research supports obesity is a significant risk factor in the development of osteoarthritis. It is pretty straightforward as body weight increases this equals increased load on the spine, and joints, especially the weight-bearing ones like the hips and knees. Increased pressure leads to early wearing, tearing, and eventual development of osteoarthritis. Added weight affects the body’s biomechanics and gait patterns.

However, obesity has also been shown to be a risk factor even on the non-weight-bearing joints. This is based on adipose tissue, which is more than just insulation. Adipose tissue is metabolically active and is involved in the secreting adipokines and cytokines which promote an inflammatory response. Pro-inflammatory adipokines and cytokines can have detrimental effects on joint tissue including damage to cartilage, synovial joints, and subchondral bone. The effect of inflammation on the joints in the body can contribute to the development of osteoarthritis.

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References

Causes of Cauda Equina: Neurosurgical Focus. (June 2004) “Spinal epidural hematoma causing acute cauda equina syndrome” pubmed.ncbi.nlm.nih.gov/15202871/

Arriving at a Diagnosis: British Journal of Neurosurgery. (August 2010) “Reliability of clinical assessment in diagnosing cauda equina syndrome” www.tandfonline.com/doi/abs/10.3109/02688697.2010.505987