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The most common cause of cauda equina syndrome is a herniated disk.
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Cauda equina syndrome causes severe pain in the lower back, urinary problems (such as incontinence). and loss of sensation in the buttocks, genital area, bladder, and rectum.
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Doctors immediately evaluate people with symptoms of cauda equina syndrome and do magnetic resonance imaging or computed tomography to confirm the diagnosis.
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Surgery is often needed to relieve pressure on the cauda equina, and pain relievers and corticosteroids are used to relieve pain.
A bundle of nerves extends downward from the bottom of the spinal cord, through the lower back bones (vertebrae) and over the bone at the base of the spine (sacrum). This bundle is called the cauda equina, which means horse’s tail in Latin, because that is what the bundle looks like. The symptoms that result from compression of or damage to the cauda equina are called the cauda equina syndrome.
Cauda Equina Syndrome
Causes
The most common cause of cauda equina syndrome is
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A ruptured or herniated disk in the lower spine, especially in people who are born with a narrow spinal canal
Other causes include the following:
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Birth defects of the spinal cord (such as spina bifida)
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Infection of the spinal cord
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An abscess (a collection of pus) pressing on the cauda equina
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Spinal stenosis (narrowing of the passageway that contains the spinal cord)
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Arteriovenous malformation (an abnormal connection between blood vessels supplying the cord)
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Complications after surgery on the spine
Some of these conditions cause inflammation and/or swelling, putting pressure on the nerves.
Symptoms
People with cauda equina syndrome may have severe pain in the lower back, usually due to the disorder causing cauda equina syndrome. People may lose sensation in the buttocks, genital area, bladder, and rectum—the area of the body that would touch a saddle (called saddle anesthesia). That is, these people may be less able to feel pain, touch, temperature, and vibration in these areas.
Sensation and muscle control may be impaired in the lower legs.
Other symptoms of cauda equina syndrome may include the following:
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Reduced sexual response, including erectile dysfunction in men
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Loss of bladder control (urinary incontinence)
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Loss of bowel control (fecal incontinence)
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Loss of reflexes in the knee and ankle
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Problems walking
Without treatment, cauda equina syndrome can cause complete paralysis.
Diagnosis
Doctors suspect cauda equina syndrome based on symptoms and results of a physical examination. However, symptoms tend to vary.
Magnetic resonance imaging (MRI) or computed tomography (CT) can usually confirm the diagnosis. Sometimes another imaging test, such as myelography with CT, is done to rule out other disorders that cause similar symptoms.
Treatment
People who have cauda equina syndrome require immediate medical attention.
Doctors focus on treating the disorder causing cauda equina syndrome. For example, surgery is done immediately to relieve pressure on the cauda equina caused by a herniated disk. Such treatment can prevent permanent damage.
Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers are used. If these drugs do not relieve the pain, corticosteroids, given by mouth or injection, may help. Corticosteroids can also reduce swelling.
How well a person recovers often depends on the cause and how promptly it are treated. Symptoms are more likely to lessen or go away if the cause is identified and is treated immediately.
