Mississauga Chiropractor Presents: Cauda Equina Syndrome

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Here`s another blog from a Mississauga Chiropractor…

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Cauda Equina Syndrome is an acute neurocompressive disorder of the lumbar spine where the cauda equine of the spinal cord becomes compressed resulting in serious neurologic symptoms below the level of the lesion.  The usual cause is a large central disc herniation applying intrinsic pressure on the cauda equine.  It can occur at the following spinal levels:  L4-L4, L4-L5 or L5-S1

 

Demographics: Incidence – <1 % of patients with low back pain (very rare, but serious)

 

Potential Causes:

a)      Trauma – Fracture or Severe Swelling

b)      Lumbar Disc Disease

c)      Abcess

d)      Tumor, Metastatic condition

e)      Late-stage Atherosclerosis

f)        Epidural Hematoma

 

History:

a)      Patient may present with lumbar spine pain of rapid onset following heavy lifting or twisting

  1. There is low back pain accompanied with bilateral sciatica
  2. Acute or chronic radiating pain
  3. Unilateral or bilateral lower extremity motor and/or sensory abnormality

b)      Usually associated with saddle anesthesia – patient may notice a difference in feeling when wiping after a bowel movement

c)      Most significant finding leading to the diagnosis of Cauda Equina Syndrome is urinary or defecation retention

 

Diagnostic Imaging:

a)      MRI: Gold standard for the initial evaluation of patients with Cauda Equina Syndrome

b)      CT: not superior to MRI but is the study of choice in patient who can`t have an MRI (e.g. presence of body metal)

c)      X-Ray:  little use, may help locate destructive changes or disc space narrowing

 

Management:

a)      Referral for emergency advanced imaging: MRI, CT

b)      Surgical decompression within hours of patient presentation to prevent further progression & increase chance of neurological recovery:  decompressive laminectomy

  • Potential consequences of delayed treatment include residual weakness, incontinence, impotence & sensory abnormalities

 

 

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