What is cauda equina syndrome or CES ?

Cauda equina syndrome is a neurological condition and is generally considered as a form of spinal cord injury.

The cauda equina, otherwise known as the horse’s tail, is called this because of its appearance. It is situated at the lower end of the spinal cord. The spinal cord is shorter than the spinal canal in which it runs. It ends at the first or second lumbar vertebrae. The cauda equina contains the nerve roots from L1-5 and S1-5.

Cauda equina syndrome can often be caused by compression of this group of nerves. It has been defined as low back pain, sciatica with pain in one or both legs, sensory disturbance around the saddle area, loss or altered function of the bladder and bowel, and variable lower extremity motor and sensory loss.


What can cause cauda equina syndrome ?

Cauda equina syndrome is caused by significant narrowing of the spinal canal which compresses the nerve roots below the level of the spinal cord.

There are a number of possible causes which include the following :

  1. Compression of the nerves by prolapsed disc, or any other form of spinal injury such as a fracture
  2. Stretching for example, where one vertebrae slips on another
  3. Inflammation, in conditions such as an abscess in the spine.
  4. Spinal tumours
  5. Lumbar puncture or spinal tap. This can cause a collection of blood in the spinal canal in patients receiving medication to thin the blood. This collection of blood has been seen to compress the nerves and cause CES.

CES due to compression, for example when there has been a fracture, may respond well to speedy decompression surgery, but how well a person will recover will depend upon how long the syndrome continued before decompression was achieved.


Management

If a person has chronic cauda equina syndrome it can be much harder to treat.

The pain is usually treated with strong analgesia. If the person has problems with bladder control, medication will be given or the person may have to use intermittent self-catheterisation if the bladder is unable to empty.

Other ongoing problems may include bowel symptoms with incontinence of faeces but also incontinence of flatus. A common problem is severe constipation and so enemas and other measures such as laxatives may be necessary.

There may be sexual dysfunction with sensory loss and in males, a complete loss of sexual function.

There may be loss of sensation in the feet or legs. Some people describe having small areas of sensation on the base of the foot, but when in a standing position, they do not have full sensation in the base of the foot, and so have problems with balance.


What can happen if there is a delay in diagnosis ?

The longer this condition is left untreated, the more damage can result. Many experts provide opinions in this field. Some will say that once there is incontinence of urine, then even with decompression surgery, the outcome for the patient will be very poor. However, others say that there is a window of 24-48 hours for surgery, and if decompression is achieved within this timescale, the outcome for the patient will be much better. They may have some residual disabilities, but will generally be able to manage day to day tasks and will generally have enough bowel and bladder control to enable them to continue working.


Can I make a claim ?

All of these cases have to be looked at on their individual facts. However, if you feel there has been a delay in diagnosing and treating your cauda equina syndrome, then please contact Thompsons' serious injury team.