Spotlight on: Cauda Equina Syndrome

What is the Cauda Equina?

The collection of nerves at the end of the spinal cord is known as the cauda equina, due to its resemblance to a horse's tail. The spinal cord ends at the upper portion of the lumbar (lower back) spine. The individual nerve roots at the end of the spinal cord that provide motor and sensory function to the legs and the bladder continue along in the spinal canal. The cauda equina is the continuation of these nerve roots in the lumbar region. These nerves send and receive messages to and from the lower limbs and pelvic organs.

What is Cauda Equina Syndrome CES?

Simply put Cauda Equina Syndrome is a rare and severe type of spinal stenosis (narrowing of the spaces within your spine), where all of the nerves in the lower back suddenly become severely compressed.

CES most commonly results from a massive herniated disc in the lumbar region. A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as a person ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.

CES also has many other potential causes including spinal lesions and tumours, spinal infections, trauma (such as from road traffic accidents), to name a few.

What are the symptoms (Red flags)?

Symptoms include:

• sciatica on both sides

• severe low back pain

• weakness or numbness in both legs that is severe or getting worse

• numbness around or under your genitals, or around your anus

• recent problems with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it

Those diagnosed with CES, will need prompt treatment to relieve pressure on nerves. CES is a medical emergency requiring hospital admission and surgery (ideally within 24-48 hours) because the longer it goes untreated, the greater the chance it will lead to permanent paralysis and incontinence.

Living With Cauda Equina Syndrome

If permanent damage has occurred, surgery cannot always repair it. CES is chronic and therefore support is needed to learn ways to adapt to changes in the body's functioning.

In some cases people with CES are admitted to a specialist spinal unit who can provide support, education and rehabilitation for mobility, bladder, bowels and sexual function.

I have worked at Salisbury Spinal Unit (on and off) for 8 years now and have treated many patients with CES. From a physiotherapy point of view my job is to help people improve their strength and mobility as much as possible to allow them to maximise their independence.

However, given that CES is such a rare condition I was very shocked when one of my own family members was admitted to the spinal unit this year with this exact condition. My cousin's husband suffered from severe lower back pain, then quickly developed more worrying symptoms.

He had decompression surgery after being diagnosed with CES however has been left with many chronic symptoms which he is having ongoing rehabilitation for.

As a side note from working at the Spinal Unit this year, I have to highlight for ANYONE having to be in hospital for any length of time in 2020, is just horrendous. Due to the fact that the spinal unit is regional, many patients are hours away from home and have had to cope with life changing injuries with very limited visiting from family. The staff do an amazing job to support people but I have huge respect for what people have had to go through this year.

Anyway, the great news is that he is now home with his family and has made amazing progress. He has set up his own awareness page and blog to help others who have been affected by CES and improve the understanding of this condition in the wider community. If you or anyone you know has been affected by this then please check out his page here.

Finally, just remember if you or anyone you know suffers from these symptoms then do not be afraid to get medical advice as soon as possible, as it could have a massive impact on someone's life.