Back pain health centre

Cauda equina syndrome

With cauda equina syndrome, nerves at the base of the spinal cord become compressed. This affects nerves important for messages to the legs, feet and pelvic organs.

This is a serious condition, which can cause lower back pain, numbness, paralysis and bowel or urine problems.

Cauda equina syndrome is a medical emergency needing urgent hospital treatment to avoid permanent bladder and bowel problems.

Causes of cauda equina syndrome

Cauda equina syndrome occurs more often in adults than in children, but it can occur in children who have a spinal birth defect or have had a spinal injury.

These are the most common causes of cauda equina syndrome:

• A herniation (bulging) of a spinal disk in the lumbar area that presses on the nerves - the most common cause
• Narrowing of the spinal canal (stenosis)
• A spinal lesion or tumour
• A spinal infection, inflammation, haemorrhage or fracture
• A complication from a severe lumbar spine injury such as a car crash, fall or other traumatic injury such as a stabbing
• A birth defect such as an abnormal connection between blood vessels (arteriovenous malformation)

Symptoms of cauda equina syndrome

It may be hard to diagnose cauda equina syndrome. Symptoms vary and may come on slowly. They also mimic other conditions. If you have any of these symptoms, seek medical advice right away:

• Severe lower back pain
• Pain, numbness or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair
• Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your leg, or feet that is severe or gets worse and worse. You may experience this as trouble feeling anything in the areas of your body that would sit in a saddle - called saddle anaesthesia
• Recent problems with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it ( incontinence)
• Sexual dysfunction that has come on suddenly

Diagnosing cauda equina syndrome

If you develop any of the above symptoms, seek medical advice immediately or visit the accident and emergency department of your nearest hospital. Here's what you may need to confirm a diagnosis:

• A medical history, in which you answer questions about your health, symptoms and activity
• A physical examination to assess your strength, reflexes, sensation, stability, alignment, and movements. You may also need blood tests
• MRI scan, which uses magnetic fields and computers to produce three-dimensional images of your spine
• A myelogram - an X-ray of the spinal canal after injection of contrast material - which can pinpoint pressure on the spinal cord or nerves
• CT scan

Treating cauda equina syndrome

You'll need prompt treatment to relieve pressure on nerves. Surgery must be done quickly to prevent permanent damage, such as paralysis of the legs, loss of bladder and bowel control, sexual function or other problems. It is best if this occurs within 48 hours of the onset of symptoms. Depending on the cause of your cauda equina syndrome you may also need high doses of corticosteroids. These can reduce swelling. If you are diagnosed with an infection you may need antibiotics.

Even with treatment, you may not retrieve full function. It depends on how much damage has occurred. If surgery is successful, you may continue to recover bladder and bowel function over a period of years.