The cauda equina is formed by nerve roots caudal to the level of spinal cord termination. Cauda equina syndrome is a combination of low back pain, unilateral or usually bilateral sciatica, saddle sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss. Cauda equina syndrome is a medical emergency and immediate referral for investigation and treatment is required to prevent permanent neurological damage.1 Epidemiology Cauda equina syndrome is rare. It occurs mainly in adults but can occur at any age. The most common cause of cauda equina syndrome is herniation of a lumbar intervertebral disc. Causes Herniation of a lumbar disc Tumours: metastases, lymphomas, spinal tumours Trauma Spinal stenosis Infection, including epidural abscess2 Congenital, e.g. congenital spinal stenosis, kyphoscoliosis and spina bifida Spondylolisthesis Late-stage ankylosing spondylitis Post-operative haematoma Following spinal manipulation3 Inferior vena cava thrombosis Sarcoidosis Presentation Most cases are of sudden onset and progress rapidly within hours or days. However cauda equina syndrome can evolve slowly and patients do not always complain of pain. Low back pain, with pain in the legs and unilateral or bilateral lower limb motor and/or sensory abnormality. Lower limb motor weakness and sensory deficits: usually asymmetrical weakness with loss of reflexes dependent on the affected nerve root (increased lower limb reflexes and other upper motor neurone signs such as extensor plantar responses may indicate spinal cord involvement and exclude the diagnosis of cauda equina syndrome). Bowel and/or bladder dysfunction with saddle and perineal anaesthesia. Urinary dysfunction may include retention, difficulty starting or stopping a stream of urine, overflow incontinence and decreased bladder and urethral sensation. Bowel disturbances may include incontinence, constipation. Rectal examination may reveal loss of anal tone and sensation. Sexual dysfunction. Investigations The diagnosis is usually possible from the history and examination. Further investigations are focused on localising the site of compression and the underlying cause. MRI scan is usually the preferred investigation to confirm the diagnosis and determine the level of the compression and any underlying cause. Myelography and CT are also sometimes used. Urodynamic studies: may be required to monitor recovery of bladder function following decompression surgery. Differential diagnosis Conus medullaris syndrome (the conus medullaris is located above the cauda equina at T12-L1; nerve root pain is less prominent and the main features are urinary retention and constipation4) Mechanical back pain or prolapsed lumbar disc Fracture of lumbar vertebrae due to trauma Spinal tumour Spinal cord compression Peripheral neuropathy Management Patients should be referred immediately for a neurosurgical consultation. Urgent surgical spinal decompression is indicated for most patients to prevent permanent neurological damage. Immobilise spine if cauda equina syndrome is due to trauma. Surgery is indicated to remove blood, bone fragments, tumour, herniated disc or abnormal bone growth. For patients with a herniated disk as the cause of cauda equina syndrome, early surgical decompression is recommended.5 Lesion debulking is required for space occupying lesions, e.g. tumours, abscess. If surgery cannot be performed, radiotherapy may relieve cord compression caused by malignant disease. Other treatment options may be useful in certain patients, depending on the underlying cause of the cauda equina syndrome: Anti-inflammatory agents, including steroids, can be effective in patients with inflammatory causes, e.g. ankylosing spondylitis. Infection causes should be treated with appropriate antibiotic therapy. Patients with spinal neoplasms should be evaluated for chemotherapy and radiation therapy. Postoperative care includes addressing lifestyle issues, e.g. obesity, and also physiotherapy and occupational therapy, depending on residual lower limb dysfunction. Complications Complications are increasingly likely if diagnosis and appropriate management is delayed, and include residual: Weakness Incontinence Impotence Sensory abnormalities Prognosis Prognosis is dependent on the etiology and the time taken before effective treatment is provided. A degree of bladder and bowel function may be permanently lost. Late diagnosis and treatment increases the risk of a permanent neurological deficit. Patients with bilateral sciatica or complete perianal anesthesia have a less favorable prognosis than patients with unilateral pain. Also this was not said to me........................ ..................
Nor was it treated in the 48 hours
Damage can be so severe and/or prolonged that nerve regrowth is impossible. In such cases the nerve damage will be permanent. In cases where the nerve(s) has been damaged but is still capable of regrowth, recovery time is widely variable. Quick surgical intervention can lead to complete recovery almost immediately afterward. Delayed or severe nerve damage can mean up to several years recovery time because nerve growth is exceptionally slow.
These were taken by a student nurse then she was about to take the stri strips off.
Before they were taken off Then after a neat scar which I still have as well as being lumpy.
Well not been here for a while winter seems to be on its way out now,thank goodness/.
There are many signs of spring have seen many flowers and the sun has been out, the evenings are getting longer. No more dark and dreary evenings.
OK so a little update on me the battles with my weight and coping with my illness.
Weight first is good I have gone down from 26 to 24 nearly 22. Especially with tops and underwear at last. I have thrown out all my clothes that are to big so I don't slip backwards.
Last month when I saw my GP I had lost 3 kilos. So I really hope I can achieving this again.
Dealing with CES well its seems to me not improving. I still have pain in my legs every time I go to get up or when I have been out walking. Its one of those no win situations. I am now having to take movacole for my bowls which is working but my stools have gone very soft to where I spend 10 mins having to clean myself with wipes and now having to wear pads 24/7. That is so going to look sexy for my wedding (not).
After doing some more research on CES I have found that if I was treated from the moment I complained about pains in my back and legs I would may of recovered fully by now.
But as it was left longer than 48 hours they say it ill take seval years for regrowth of nerves.
So this explains why 2 years on I am no better.
Am off to see ym GP on TUesday to ask if I can have a baby while on these tablets as I have tried to come off them but as I am still in pain and have crump again in my left foot.
My wedding plans are going well I have all the bits ready cut out to make the invitations this week so I can get them out next month.
AS we now down to 6 months to go.
Pretty scary really as I never thought I would get this far in planning.
Due to past experiances.
I do know this is going to happen but still feels unreal.
