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Cauda Equina Injury

Spinal Cord Injury of Cauda Equina


Presentation

  • Presented is a case series of 3 patients, all of whom developed neurologic deficits due to cord or cauda equina compression during elective extremity surgery.[ncbi.nlm.nih.gov]
  • If a patient experiences these symptoms, he or she should present immediately to a Hospital Emergency Department.[hayneslawyers.com]
  • Recorded at the Royal Society of Medicine, 1 Wimpole Street, London To view this cauda equina syndrome video presentation click the arrow below.[lipkinhiggins.com]
  • Presented at the annual meeting of the New England Surgical Society, New Haven, Connecticut, October 1, 1948.[nejm.org]
  • A 43-year-old man was presented with a stab wound to the right lumbar region, with immediate paralysis of the left lower extremity accompanied by loss of perineal sensation.[journals.lww.com]
Wound Infection
  • Follow-up showed bony union with no further displacement or internal fixation failure, wound infection, delayed healing, or compression of the skin by the plate and screws.[ncbi.nlm.nih.gov]
Asymptomatic
  • Dave’s cervical spine was asymptomatic. Even so, I examined it, performing range of motion, compression tests, stretch tests, upper extremity deep tendon reflexes, superficial sensation and myotomal strength.[chiro-trust.org]
Limb Pain
  • Common outcomes after surgery include; lower limb pain, numbness and paralysis, lack of bladder and bowel control, loss of sexual function, and mental health issues from such changes.[shine.com.au]
Fecal Incontinence
  • Incontinence Urinary Retention: due to detrusor muscle weakness Urinary Incontinence Low Back Pain/Sciatica : sciatica may be unilateral or bilateral Variable Lower Extremity Sensory/Motor Dysfunction Lower Extremity Weakness: bilateral or unilateral[mdnxs.com]
  • He also reports difficulty urinating and some fecal incontinence. Examination reveals generalized lower extremity weakness, saddle paresthesia, hyporeflexia in the lower extremities, and loss of rectal tone.[orthobullets.com]
  • Patient’s may also experience overflow incontinence and present with urinary and/or fecal incontinence (inability to control bowel and/or bladder function).[princetonneurologicalsurgery.com]
  • The stool softener or manual evacuation for fecal incontinence may be advised for constipation. For heterotopic ossification stretching exercises, disodium, radiation, and surgical excision are the treatment options.[boneandspine.com]
  • incontinence Present later Only urinary retention 14.[slideshare.net]
Back Pain
  • Differentiating between routine back pain and back pain with associated neurological complications is critical because cauda equina must be surgically treated within a short window of opportunity before permanent deficits are likely to occur.[hayneslawyers.com]
  • Cauda Equina Syndrome Recovery – Now Possible with Our Help You could say that lower back pain is a normal part of life. Annoying, yes, but it exists. For most people, the pain disappears without treatment.[centerforneurorecovery.com]
  • The syndrome is characterized by varying patterns of low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction.[chiro-trust.org]
  • That being said and from a risk management standpoint, it isn’t necessary to order an MRI on all patients with back pain, as the large majority of patients in the ED with back pain do not need further workup.[aliem.com]
Suggestibility
  • Impaired postprandial tone and phasic motor function of the descending colon after spinal cord injury with normal sigmoid motility suggests regional differences in the effect of denervation.[ncbi.nlm.nih.gov]
  • When clinical signs suggested a possible U-shaped sacral fracture, a 2- to 3-mm cut computed tomography scan with coronal and sagittal reconstruction can provide optimal imaging to identify and evaluate the sacral fracture.This article describes 2 patients[ncbi.nlm.nih.gov]
  • Our results show that implantation of avulsed lumbosacral ventral roots into the spinal cord promotes reinnervation of the urinary tract and return of functional micturition reflexes, suggesting that this surgical repair strategy may also be of clinical[jneurosci.org]
  • Magnetic resonance imaging suggested rupture of the cauda equina nerves at the L3 to L4 level. The patient was taken immediately for surgery for irrigation and debridement.[journals.lww.com]
  • Anecdotal evidence suggests this is a bigger problem in the UK than in countries with similar healthcare systems.[bjgp.org]
Urinary Retention
  • CONCLUSION: The results indicate that the EA treatment may have longlasting therapeutic effectiveness in the management of neurogenic urinary retention secondary to cauda equina injury.[ncbi.nlm.nih.gov]
  • At 12 weeks after operation, the avulsed group demonstrated urinary retention, absence of bladder contractions and external urethral sphincter (EUS) electromyographic (EMG) activation during urodynamic recordings, increased bladder size, and retrograde[jneurosci.org]
  • Patients with demonstrated urinary retention are more likely to have CES. Domen et al. found that 75% of patients with CES had urinary retention of more than 500 mL after voiding.[aliem.com]
  • However, in our experience clinicians often wait until the patient has reached urinary retention before treating the situation as an emergency, which is often too late.[stewartslaw.com]
  • Cauda Equina Syndrome Symptoms Cauda equina syndrome is roughly categorized into 2 basic types, according to the defining symptom of urinary retention. Complete cauda equina is accompanied by urinary retention while incomplete is not.[verywellhealth.com]
Urinary Incontinence
  • Suprapubic endoscopic suspension of the vesical neck is a popular and effective procedure for the treatment of stress urinary incontinence in women.[ncbi.nlm.nih.gov]
  • Statistical analysis showed significant correlations between (1) a compromised bulbocavernosus reflex and perineal floor neuropathy (.01 less than P less than .05) and (2) sex of the patient and incidence of urinary incontinence among subjects with perineal[ncbi.nlm.nih.gov]
  • Medical conditions, medications, and urinary incontinence. analysis of a population-based survey. Can Fam Physician. 2002; 48 :96–101.[aliem.com]
  • Cauda equina syndrome USMLE Step 1 style questions 2 questions Cauda equina syndrome USMLE Step 2 style questions 2 questions Preview A 60-year-old woman comes to the emergency department because of urinary incontinence and bilateral medial thigh paresthesia[osmosis.org]
  • Recent-onset urinary retention (caused by bladder distension because the sensation of fullness is lost) and/or urinary incontinence (caused by loss of sensation when passing urine).[medicalprotection.org]
Overflow Incontinence
  • Cauda equina syndrome with retention or overflow incontinence. Incontinence at presentation is a poor prognostic sign.[aci.health.nsw.gov.au]
  • Patient’s may also experience overflow incontinence and present with urinary and/or fecal incontinence (inability to control bowel and/or bladder function).[princetonneurologicalsurgery.com]
  • Overflow incontinence is the problem caused by cauda equina syndrome and is very different than stress incontinence. The bladder cannot send signals to the brain regarding the amount of urine contained in the bladder and the bladder overfills.[neckandback.com]
  • incontinence Bowel dysfunction (constipation and/or incontinence) – up to 74% ( Korse 2017 ) Decreased sensation in the perianal area – up to 93% ( Korse 2017 ) Sexual dysfunction (i.e. impotence) Physical Exam Saddle Paresthesia Lower extremity weakness[rebelem.com]
  • The syndrome becomes complete when the bladder is no longer under voluntary control and the patient has painless urinary retention with dribbling overflow incontinence (CESR).[mddus.com]
Urinary Stress Incontinence
  • Case 1: Bilateral Motor Conduction Studies on the Tibialis Posterior Nerve Case 2 A 65-yr-old woman underwent perineoplasty because of urinary stress incontinence. Her spinal anesthetic was unremarkable.[anesthesiology.pubs.asahq.org]
Irritability
  • Compression, irritation, or other trauma to these nerve roots can result in multiple symptoms, ranging from mild sciatica to complete paralysis.[virginiatrialfirm.com]
  • Cauda equina syndrome can be caused by any condition that results in direct irritation or pinching of the nerves at the end of the spinal cord.[medicinenet.com]
  • The doctor could have confirmed CES using radiology and neurological testing including NCV (nerve conduction velocity) and EMG (electromyography) that would have identified lower back nerve irritation.[rosenfeldinjurylawyers.com]
  • Cauda Equina Syndrome Described Cauda equina syndrome is a rare condition in which exposed nerve fibers located at the bottom of the spinal cord become irritated. The irritation is caused by something with which the exposed nerves come into contact.[verywellhealth.com]
  • Massage is not always contraindicated and there are key benefits massage can offer in reducing excessive sensory irritation.[academyofclinicalmassage.com]
Clumsiness
  • Numbness and/or tingling sensation felt in the areas of the body that would touch a saddle when sitting on a horse, also known as saddle anesthesia Weakness, discomfort, and/or stiffness in the legs Difficulty walking and keeping balance, as well as clumsiness[spines.com]
  • Altered sensation or clumsiness in the lower legs may be indicative of nerve compression. It is common for people with cauda equina syndrome to report bowel, bladder, or sexual dysfunction that is of a relatively recent onset.[academyofclinicalmassage.com]
  • Although his back was quite painful and stiff, his legs ached and they felt weak and clumsy. It is our standard inquiry to ask about bowel, bladder, and sexual function.[chiro-trust.org]
Neglect
  • However, when treating professionals fail to meet the prevailing standard of care by neglecting the possibility of CES in a patient showing signs of neurological impairment or compression of the spinal cord, actionable malpractice can occur.[pricebenowitz.com]
Numbness in the Buttocks
  • Symptoms which should prompt urgent action include loss of sensation in the lower limbs, numbness in the buttocks / genitial area and difficulties passing urine or with bowel movements.[penningtons.co.uk]

Workup

  • Neurologic examination should be routinely performed in the recovery room; and if significant neurologic deficits are seen, investigative workup should not be delayed.[ncbi.nlm.nih.gov]
  • The authors concluded that ANY new urinary symptoms in the setting of back pain should prompt a workup for CES [5].[aliem.com]
  • […] meningomyelocele, neural tissues including the meninges and nerve roots protrude through a vertebral defect, typically in the lumbosacral region, and is accompanied by neurological deficits below the level of the lesion. [2] [9] [10] Other Issues The workup[ncbi.nlm.nih.gov]

Treatment

  • OBJECTIVE: To report the therapeutic effectiveness and feasibility of electroacupuncture (EA) treatment in patients with urinary retention which is caused by cauda equina injury and refractory to conventional conservative treatments.[ncbi.nlm.nih.gov]
  • Suprapubic endoscopic suspension of the vesical neck is a popular and effective procedure for the treatment of stress urinary incontinence in women.[ncbi.nlm.nih.gov]
  • Upon the completion of conservative treatment, ADC disappeared in four patients whose compliance and capacity of the bladder were normalized on follow-up urodynamic studies.[ncbi.nlm.nih.gov]
  • Cauda Equina Syndrome Prevention, Symptoms, Treatments and Causes: An article from Emedicinehealth.com discusses this rare spinal cord injury, its treatment and preventative measures.[floridainjuryclaim.com]
  • Fortunately, in most cases, diagnostic and treatment responses in such scenarios are prompt, effective and often able to halt the development of serious complications.[pricebenowitz.com]

Prognosis

  • Prognosis Cause of cauda equine and promptness of the treatment are two major factors in cauda equine syndrome. Complications are more common if treatment is delayed.[boneandspine.com]
  • […] root ) - urinary retention is the most consistent finding; - see urologic management of the spinal cord injured patient : - in spinal cord injuries, the caudal equina may sustain considerable initial trauma & stop functioning, but there may be a good prognosis[wheelessonline.com]
  • […] is rare, but devastating if symptoms persist Clinical diagnosis is not easy and even in experienced hands is associated with a 43% false positive rate The investigation of choice is magnetic resonance imaging Once urinary retention has occurred the prognosis[bmj.com]
  • […] contrast-filled thecal sac in complete blockage 2 MRI imaging modality of choice 2,3 sagittal and axial T1 and T2 sequences are usually sufficient 4 post-contrast and STIR sequences may be required if infective causes are suspected 3,4 Treatment and prognosis[radiopaedia.org]

Etiology

  • Trial lawyers whose clients suffer from cauda equina syndrome should be well versed in the etiology and treatment of the condition. Victims of automobile accidents, falls, and other trauma may develop cauda equina syndrome.[virginiatrialfirm.com]
  • Multiple etiologies can cause the cauda equina syndrome.[ncbi.nlm.nih.gov]
  • CAUDA EQUINA SYNDROME • Etiologies • Disc herniation • Disc fragment migration • Iatrogenic epidural hematoma • Post LP or spinal anesthesia • Postoperatively • Infection • Tumor • Trauma 13.[slideshare.net]
  • Definition Cauda Equina Syndrome : characteristic pattern of neuromucscular and urogenital symptoms which occurs due to the compression of multiple lumbosacral nerve roots below the level of the conus medullaris Etiology Spinal Infection Spinal Epidural[mdnxs.com]
  • […] incomplete may have loss of urgency or decreased urinary sensation without, however, incontinence or retention accounts for 40% (range 30-50%) of presentations 6 complete urinary and/or bowel retention or incontinence accounts for 60% (range 50-70%) 6 Etiology[radiopaedia.org]

Epidemiology

  • […] surgery for Cauda Equina Syndrome: A Systematic Literature Review. ( 29432394 ) Srikandarajah N....Marson T. 2018 9 Influence of timing of surgery on Cauda equina syndrome: Outcomes at a national spinal centre. ( 29657470 ) Heyes G....Eames N. 2018 10 Epidemiology[malacards.org]
  • Epidemiologic assessments regard lesions to the cauda equina as uncommon, with a prevalence of 1 to 3 per 100,000 subjects.[ncbi.nlm.nih.gov]
  • Spinal Cord injury: Definition, Epidemiology, Pathophysiology by Segun T. Dawodu, M.D.[sci.rutgers.edu]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology remains unclear but may be related to damage to the nerve roots composing the cauda equina from direct mechanical compression and venous congestion or ischemia.[chiro-trust.org]
  • Spinal Cord injury: Definition, Epidemiology, Pathophysiology by Segun T. Dawodu, M.D.[sci.rutgers.edu]

Prevention

  • Close surveillance can help prevent lasting problems. (See " FDA Safety Alert: Cauda Equina Syndrome Associated with Use of Small-Bore Catheters in Continuous Spinal Anesthesia.")[rosenfeldinjurylawyers.com]
  • Cauda equina syndrome is usually a medical emergency, requiring immediate surgery to decompress the nerves so as to prevent permanent injury.[virginiatrialfirm.com]
  • Cauda Equina Syndrome Prevention, Symptoms, Treatments and Causes: An article from Emedicinehealth.com discusses this rare spinal cord injury, its treatment and preventative measures.[floridainjuryclaim.com]
  • For patients afflicted by the onset of a rare, yet potentially debilitating spinal condition known as cauda equina syndrome (CES), timely diagnosis and commencement of treatment is critical to preventing permanent harm.[pricebenowitz.com]

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