At the base of the spine there is a group of nerves responsible for sensory and motor stimulation to the pelvis and lower limbs, as well as bowel and bladder function – these are known as cauda equina.
Cauda equina syndrome (CES) is caused by pressure and swelling on those spinal cord nerves. The pressure on the nerves at the very bottom of the spinal cord stops the nerves from working properly. It is a rare disorder but if it is not treated quickly – there is normally a window of 24 to 48 hours – it can cause permanent nerve damage with life changing consequences.
Recognising the condition in a patient can be made problematic in a busy, understaffed and underfunded medical setting where medical professionals do not have the time or, sometimes, the expertise to spot CES.
For example, low back pain caused by CES can be dismissed as typical back pain. The patient may simply be sent home with paracetamol and instructions to rest, which can have catastrophic consequences.
If the signs and symptoms of CES are present when attending hospital, a failure to act upon these symptoms within 48 hours, such as arranging for a MRI / CT scan, can be grounds for negligence.
What causes cauda equina syndrome?
CES can be caused by any condition that directly puts pressure or pinches the nerves at the end of the spinal cord.
The most common cause of CES is a herniation of lumbar intervertebral disc or prolapsed disc (often called a ‘slipped disc’).
Abnormal growths adjacent to the lower spinal cord can also cause CES. These growths could be cancerous, a tumour or cyst.
Other causes can be internal epidural bleeding, epidural abscess, bone cancer or Paget’s disease of the bone, which are localised in the lower spinal cord area.
How is cauda equina syndrome diagnosed?
CES is diagnosed based on the characteristic symptoms and confirmed by neurologic and radiology testing. Investigations will usually include an MRI scan to confirm the diagnosis, and may include a CT scan and tests of bladder control.
Early diagnosis is essential to ensure a favourable outcome.