Cauda Equina Syndrome: Symptoms and Treatments
Cauda equina syndrome is a neurologic condition that involves a loss of function of the nerve roots of the spinal canal below the termination of the spinal chord. The spinal chord extends from the base of the brain through the spinal canal inside the vertebral column. The spinal chord is actually an extension of the brain, sending sensory information to the brain, and then back out in the form of reflexes and voluntary motor movements. The spinal chord also gives us our sensations, such as pain that many of us are too familiar with. The spinal chord itself is enclosed by membranes (called dural sacs) which protect it and provide it nutrients so that it can continue to function properly. There are membranes include three membranes that provide us protection and the cerebro-spinal fluid that bring it oxygen and nutrients, and carry away waste products suck as carbon dioxide. The spinal chord begins at the top of the cervical region of the brain and continues thru the spinal canal, terminating near the first lumbar vertebra (near the base of the lower back). The termination of the spinal chord is a region called the conus medullaris. The filum terminale is the fibrous extension of the spinal chord. Inferior to the conus medullaris is the region known as the cauda equina. Cauda equina syndrome is caused by a compression of the nerved in the region known as the cauda equina. Symptoms of this compression may include back pain, reduced mobility, reduced sensitivity to the lower limbs, strength loss, and pathology to reflexes. While this disorder is degenerative, there are treatments, and a person may be able to restore lost function with conservative treatments such as acupuncture and spinal manipulation. Before we look at treatment options, let's look some of the possible causes of this syndrome.
Trauma - A patient may experience lasting damage after trauma to the area as a result of an accident of medical error perforating the region. This perforation could have been caused by an error in catheter or needle placement, or they could have sustained a wound from an object than penetrated the cavity (such as a bullet)
Lesions or Tumors - A patient may have a malignant or benign mass that has invaded the region of the cauda equina and may have grown large enough to begin pressing on the area. Eventually the lesion or mass may press on this mass of nerves to cause changes to nerve sensations in the feet and toes.
Inflammatory conditions - Certain inflammatory conditions may cause a narrowing of the spinal canal, one of many types of diseases that can compress the nerves of the cauda equina. Some of the most common inflammatory diseases associated with cauda equina include ankylosing spondylitis, chronic inflammatory demyelinating polyneuropathy, and Paget disease.
Many of the causes of cauda equina syndrome include incurable diseases such as chronic inflammatory demyelinating polyneuropathy. As such, treatments often surgical interventions that will aim to permanently take some of the pressure off the areas where the nerves are compressed. When the cause of the compression are lesions or tumors, the masses are surgically excised (removed).