Cauda Equina Syndrome

What is cauda equina syndrome?

Cauda equina syndrome is the compression of a collection of nerve roots called the cauda equina. Located at the bottom of your spinal cord, these nerve roots allow you to move and feel sensations in your legs and urinary bladder.

Nerves send and receive electrical signals all across your body. Think of nerves like power lines that send electricity to homes and businesses in your town. Severe weather may cause an old tree limb to break and fall on a power line, compressing it. This disrupts electric service to the neighborhood. First responders and electric companies are like healthcare providers and surgeons who will quickly decompress the powerlines to prevent injuries and hazards.

Compressed cauda equina nerves can cause pain, weakness, incontinence and other symptoms. Like a downed power line, if you notice symptoms, contact a healthcare provider immediately. Cauda equina syndrome can lead to permanent damage, including paralysis, if left untreated. Surgery treats cauda equina syndrome.

Cauda equina is Latin for “horse’s tail.” This collection of nerve roots is shaped like a horse’s tail.

Is cauda equina syndrome an emergency?

Yes, you should seek care immediately if you notice symptoms of cauda equina syndrome. While the condition isn’t life-threatening, it can permanently damage your body, affecting your health and quality of life. Surgery might treat several of the symptoms if performed quickly.

What are the types of cauda equina syndrome?

There are two types of cauda equina syndrome:

• Incomplete cauda equina syndrome (CES-I): Incomplete cauda equina syndrome causes you to lose urgency or sensation in your bladder and bowels. This means you can’t feel that you have to poop or pee. This affects 40% of people with cauda equina syndrome.
• Complete cauda equina syndrome (CES-R): Complete cauda equina syndrome causes urinary and/or bowel retention or incontinence. Retention means that you can’t pee or poop, and incontinence means that you can’t stop yourself from peeing or pooping. It affects about 60% of people with cauda equina syndrome.

How rare is cauda equina syndrome?

Experts estimate that cauda equina syndrome affects 1 in 30,000 to 100,000 people per year around the world. It happens in an estimated 3% of all disk herniation injuries.

What are the symptoms of cauda equina syndrome?

The symptoms of cauda equina syndrome may include:

• Lower back pain and/or leg pain (sciatica).
• Leg weakness.
• Numbness or sensations (burning, prickling, tingling) in the backs of your legs, butt, hip and inner thighs (paresthesia).
• Urinary and/or fecal incontinence.
• Urinary retention.

Visit the emergency room immediately if you experience any of these symptoms.

Can you walk if you have cauda equina syndrome?

Your ability to walk depends on what symptoms you experience. Some people don’t have any trouble walking with this condition, while others do. For example, walking may be challenging if you have weakness or numbness in your legs.

What causes cauda equina syndrome?

Compression — when something presses against the cauda equina nerve roots at the bottom of your spinal cord (L1 to L5) — causes cauda equina syndrome.

The most common cause of cauda equina compression is a herniated lumbar disk.

Other common causes of nerve root compression include:

• Infection (epidural abscess, discitis, meningitis).
• Lower back injuries.
• Lumbar spinal stenosis.
• Postoperative lumbar spine surgery complications.
• Spinal epidural hematoma.
• Spinal hemorrhages.
• Spinal lesions or tumors.

What are the complications of cauda equina syndrome?

If left untreated, or if there’s a delay in treatment, cauda equina syndrome may lead to nerve damage, which can cause the following permanent complications:

• Sexual dysfunction.
• Loss of bladder or bowel control.
• Paralysis (legs).

How is cauda equina syndrome diagnosed?

A healthcare provider will diagnose cauda equina syndrome after a physical exam, a neurological exam and testing. Your provider will review your medical history and assess your ability to:

• Stand.
• Sit.
• Walk on your heels.
• Walk on your toes.
• Bend forward.
• Bend backward.
• Bend to the sides.
• Lie down and lift your legs.

This information helps your healthcare provider learn more about your:

• Stability.
• Sensations.
• Strength.
• Reflexes.
• Alignment.
• Range of motion.

Your healthcare provider might perform a rectal exam to check your anal muscles as well.

What tests diagnose cauda equina syndrome?

Your healthcare provider might order the following imaging tests to see your bones, nerve roots and spinal cord:

• Magnetic resonance imaging (MRI).
• Computed tomography (CT) scan.
• Myelogram.

How is cauda equina syndrome classified?

A healthcare provider may classify your cauda equina syndrome as either acute or chronic. These classifications indicate what kind of treatment you need.

• Acute cauda equina syndrome: Symptoms start suddenly and get worse quickly. You’ll likely need surgery within 24 to 48 hours after symptoms begin.
• Chronic cauda equina syndrome: Your symptoms are long-lasting. You may have had symptoms for a period of time before you received care, or symptoms caused permanent nerve damage.

How is cauda equina syndrome treated?

Sudden cauda equina syndrome symptoms (acute) require emergency surgery. A surgeon will move whatever is compressing your nerve roots so they can heal. This surgery is called a lumbar laminectomy.

Following surgery, your provider may recommend:

• Taking medications to improve your bowel and bladder control.
• Self-catheterization to empty your bladder.
• Participating in physical therapy to help you regain your strength after surgery.
• Participating in occupational therapy to help you complete everyday activities.

How soon after treatment will I feel better?

Everyone heals at their own pace. You may regain feeling in your butt and legs shortly after surgery. You’ll still need to take it easy while your body heals before performing strenuous activities, even walking. It could take several weeks to months, even years before you regain control of your bladder after surgery. Your healthcare provider will explain what you can expect and what the next steps are in your healing process.

Can cauda equina syndrome be prevented?

It may not be possible to prevent all causes of cauda equina syndrome. But you might be able to reduce your risk of a herniated disk, which is the most common cause that can affect anyone. Try the following tips:

• Avoid wearing high-heeled shoes. These types of shoes may misalign your spine.
• Stop using tobacco products. Tobacco products (like cigarettes) can weaken your disks.
• Strengthen your muscles. Ask your healthcare provider about exercises you can do to strengthen your back and abdominal muscles.
• Lift properly. If you need to lift heavy objects, bend your knees and keep your back straight instead of bending at your waist.
• Practice good posture. Proper posture may reduce strain on your spine.
• Stretch. Stretch your body periodically, especially after sitting for a long time.

What is the life expectancy of someone with cauda equina syndrome?

Cauda equina syndrome doesn’t directly affect your life expectancy. But symptoms can affect your quality of life. Seek care immediately if you notice symptoms.

What’s the outlook for cauda equina syndrome?

Surgery can decompress your nerve roots. If treated quickly, it may prevent permanent nerve damage. Unfortunately, surgeons can’t reverse nerve damage after it happens. A healthcare provider will follow up with you after surgery to let you know how it went and what the next steps in your treatment plan look like. Regardless of your outcome, you’ll likely need long-term rehabilitation to address lingering pain, incontinence or muscle weakness.

It isn’t easy to live with a loss of bladder or bowel control, sexual dysfunction or other complications related to cauda equina syndrome. During this time, you may feel stress, depression or anxiety. You may have trouble with school, work or your relationships with friends and loved ones. Your care team will work closely with you to help you make changes to your routine and adapt. You may even choose to visit a mental health professional or join a support group to connect with others who share a similar experience.

When should I see a healthcare provider?

You should visit an emergency room immediately if you notice symptoms of cauda equina syndrome like:

• Lower back pain (sudden or persistent).
• Difficulty peeing or pooping.
• Difficulty walking.
• Numbness or other sensations in your upper legs and butt area.

Getting treatment as soon as possible reduces your risk of long-term complications.

What questions should I ask my healthcare provider?

1. What type of cauda equina syndrome do I have?
2. Is it acute or chronic?
3. How quickly do I need surgery?
4. How long will the surgery take?
5. How long will I be in the hospital after surgery?
6. Do I have a herniated disk?