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]

The Diabetic Foot Matt Solan presents information on the diabetic foot. Diabetes MDT Fred Robinson presents information on the diabetic foot and organisational aspects. Ankle Fractures Jim Barrie presents information on ankle fractures. [boa.ac.uk]

Incontinence at presentation is a poor prognostic sign. [aci.health.nsw.gov.au]

Cauda Equina Syndrome: presentation, outcome and predictors with focus on micturition, defecation and sexual dysfunction. Eur Spine J 2017; 26(3): 894-904. [rebelem.com]

• Inflammation

  In addition to medical malpractice, the Weill Cornell Brain and Spine Center lists the following as causes of cauda equina syndrome: Spinal disk herniation Spinal tumors Spinal infections or inflammation Lumbar spinal stenosis which is compression of [personalinjuryfirm.com]

  Treatment could include: Corticosteroids and other medications may be given to reduce inflammation and swelling. Surgery may be needed to relieve compression on the nerves of the cauda equina. [nyp.org]

  Occurring traumatically or atraumatically, CES may result from any lesion that compresses the cauda equina nerve roots, which can occur from inflammation, direct compression, ischemia, or venous congestion. [journals.lww.com]

  If the cauda equina is damaged by inflammation or compression in the low back, symptoms may be severe and may develop quickly. Early medical attention and treatment are crucial for making as full a recovery as possible. [spine-health.com]

• Difficulty Walking

  She was ultimately diagnosed with cauda equina syndrome and as a result, she suffers from permanent difficulty walking. … CAUDA EQUINA SYNDROME Expert Case … from her vertebrae. [theexpertinstitute.com]

  walking) loss or reduction of reflexes saddle anesthesia (inability to feel anything in the body areas that would sit on a saddle) Exact symptoms and their severity depend on which nerve root(s) are affected and the degree to which they are compressed [neurosurgery.columbia.edu]

  See When Back Pain May Be a Medical Emergency If patients with cauda equina syndrome do not receive treatment quickly, adverse results can include paralysis, impaired bladder, and/or bowel control, difficulty walking, and/or other neurological and physical [spine-health.com]

• 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]

  Urinary and/or fecal incontinence. The overfull bladder can result in incontinence of urine. Incontinence of stool can occur due to dysfunction of the anal sphincter. [aans.org]

• Back Pain

  Conus medullaris has low back pain. Radicular pain is absent. CES back pain is less severe. Radicular pain is present in CES. Mnemonic: medulla has two L's for low back pain. Conus medullaris frequently causes impotence. In CES, impotence is absent. [medicowesome.com]

  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]

  The five diagnostic categories for spinal disorders (CSAG 1994) Simple back ache (accounts for approx. 95% of back pain). Nerve root pain (accounts for less than 5% of back pain). [rdehospital.nhs.uk]

  […] urinary symptoms The end-point of a long history of chronic back pain with or without sciatica. [aci.health.nsw.gov.au]

  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]

• Leg Pain

  Note: Some back pain and leg pain patients are prescribed injections and medications to deal with and even reduce the pain. These treatments may mask the pain while cauda equina syndrome persists. [rethwillchiroclinic.com]

  CES can lead to lumbar pain, leg pain, numbness, paralysis or bowel and bladder dysfunction. CES is an emergency condition that requires immediate medical attention. [laserspineinstitute.com]

  Despite this being a relatively unusual diagnosis, a key message is that this diagnosis has to be considered in all patients with severe back and leg pain (for example, particularly if the back pain is deteriorating and when there may be bilateral leg [bjgp.org]

  Severe back pain. Leg pain affecting one or both legs. Motor weakness and loss of reflex(es). Patients presenting with true Cauda Equina Syndrome should present themselves to the Accident and Emergency Department. [rdehospital.nhs.uk]

  People with pain in both legs (bilateral sciatica ) have less chance or full recovery than persons with single leg pain (unilateral sciatica). [emedicinehealth.com]

• Muscle Weakness

  Lower extremity muscle weakness and loss of sensations Reduced or absent lower extremity reflexes. Difficulty standing or walking. [nyp.org]

  weakness and altered sensation. [rdehospital.nhs.uk]

  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 Lower Extremity Paraplegia: bilateral or unilateral Saddle [mdnxs.com]

  Symptoms Cauda equina syndrome can cause a variety of symptoms, including: severe low back pain bladder dysfunction such as urinary retention or incontinence (loss of control) bowel incontinence (loss of control) muscle weakness or sensory loss in both [neurosurgery.columbia.edu]

• Arthritis

  Spine and Arthritis Advanced Procedure for Cancerous Spinal Tumors Arthritis Treatment Back and Spine Cauda Equina Syndrome Spinal Stenosis Spinal Tumors Spinal Nerve Damage Cauda equina syndrome is a serious condition caused by compression of the nerves [nyp.org]

  Causes of CES can include: Trauma A herniated or bulging disc Spinal stenosis Tumors Paget’s disease Ankylosing spondylitis Spondylolisthesis Bone spurs Arthritis of the spine Preventing and treating cauda equina syndrome (CES) The only way to prevent [laserspineinstitute.com]

  […] haematoma); history of severe arthritis or morning stiffness (?rheumatological) There is often a history of trauma; this does not rule out malignant disease and these patients should still be investigated. [oxfordmedicaleducation.com]

  This syndrome may also be caused by: Accident that crushes the spine, such as a car accident or fall Penetrating injury, such as a knife or gunshot wound Arthritis, such as ankylosing spondylitis Complications from spinal anesthesia Mass lesion, such [cancercarewny.com]

• Neck Pain

  By Anne Asher, CPT Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert. Thanks for your feedback! [verywellhealth.com]

  Lipani is a specialist in the treatment for cauda equina syndrome and many other spinal conditions such as spinal stenosis, herniated discs, degenerative disc disease, low back pain, neck pain, spinal tumors, spinal cancer and more. Dr. [princetonneurologicalsurgery.com]

  CSM is characterized by compression of the spinal cord and/or nerve roots, which leads to neurological signs and/or neck pain. [tr-ex.me]

  In this case, the patient had acute, but transient, neck pain following a short coughing episode. [intechopen.com]

• Radiculopathy

  In a patient with a history of back pain/ radiculopathy who presents with bladder/bowel disturbances mandates MRI study. [boneandspine.com]

  […] two sets of symptoms/signs 1-3 : perianal and "saddle" paraesthesia bowel, bladder and/or sexual dysfunction There is a host of associated symptoms and signs, which may be unilateral or bilateral and have a variable presence 1-3,6,10 : low back pain radiculopathy [radiopaedia.org]

  […] isolated Brown-Séquard syndrome) Epidural Haematoma Epidural abscess Intervertebral disc herniation Vertebral fracture or subluxation Causes of symptoms mimicking MSCC and cauda equina syndrome Musculoskeletal back pain Muscle spasm / sprain Acute spinal radiculopathy [oxfordmedicaleducation.com]

  Healthcare professionals can view the full updated guidance at: https://cks.nice.org.uk/sciatica-lumbar-radiculopathy#! [medicalprotection.org]

• Areflexia

  The predominant CMG finding was detrusor areflexia (93%). Neuropathic EMG changes were noted in 67% and a positive BST response in 95% of the cases. [ncbi.nlm.nih.gov]

  If the cauda equina is damaged, LMN type of lesion will occur - with hyporeflexia or areflexia Mnemonic: Cauda equina is the lower part of the spinal cord - LMN signs In conus medullaris, perianal hypo/anaesthesia occurs. [medicowesome.com]

  […] sacral region than it is in the cervical region Anterior Epidural Space Anatomy Anterior epidural space is a virtual space under normal circumstances (due to adherence of dura to bone of vertebral bodies from the foramen magnum down to L1) Clinical Areflexia [mdnxs.com]

  Reflexes Diminished- at the level Brisk- below the level Diminished Radicular pain - + Low back pain More Less Impotence Frequent Absent Numbness Symmetrical Asymmetrical Motor strength Symmetric Hyperreflexic Distal paresis of lower limbs Asymmetric Areflexia [slideshare.net]

• Limb Weakness

  A patient with acute cauda equina syndrome [saddle anesthesia, bilateral lower limb weakness, loss of bowel or bladder control] should not be continued on medical treatment beyond 24 hours. [boneandspine.com]

  The patient was referred to our tertiary neurosurgical unit with a 24 hour history of severe lower back pain, altered perianal sensation and right lower limb weakness. An urgent MRI scan showed a large L5/S1 disc prolapse ( Figure 1 ). [f1000research.com]

• Hypesthesia

  Neurologic assessment was consistent with a diagnosis of cauda equina syndrome, revealing hypesthesia in the S2-S4 dermatomes. [anesthesiology.pubs.asahq.org]

  Findings also may include sciatica, failure to achieve an erection, a diminished or absent patellar, Achilles, or anal reflex, and loss of rectal sphincter tone with perianal hypesthesia. [ncbi.nlm.nih.gov]

• 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]

• Sexual Dysfunction

  Cauda Equina Syndrome: presentation, outcome and predictors with focus on micturition, defecation and sexual dysfunction. Eur Spine J 2017; 26(3): 894-904. [rebelem.com]

  Sexual dysfunction can be devastating and may lead to relationship difficulties and depression. [verywellhealth.com]

  These symptoms include: Severe back pain Incontinence Sexual dysfunction Pain in one or both legs If the symptoms are ignored or misdiagnosed the neurological effects can be devastating – decompression surgery to relieve the pressure on the spine needs [irwinmitchell.com]

  These deficits can include permanent nerve damage in the legs, foot drop, permanent bowel and/or bladder dysfunction, sexual dysfunction, chronic pain, and other permanent problems. [hayneslawyers.com]

• 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]

  The previous guidelines required urinary retention or urinary incontinence. The revised guidelines have a lower threshold and include “difficulty initiating micturition [urinating] or impaired urinary flow”. [stewartslaw.com]

  Sexual dysfunction (i.e. impotence) Physical Exam Saddle Paresthesia Lower extremity weakness, numbness or paresthesias (usually bilateral) Decreased or absent lower extremity reflexes Hypotonia/atrophy of the lower extremities (in chronic presentations) Urinary [rebelem.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]

  […] can result in permanent paralysis and urinary incontinence It is very difficult to diagnose CES; in many cases, an accurate diagnosis is often delayed. [dovemed.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]

  […] flow, if untreated this may lead to irreversible urinary retention with overflow urinary incontinence Loss of sensation of rectal fullness, if untreated this may lead to irreversible faecal incontinence Perianal, perineal or genital sensory loss (saddle [medicalprotection.org]

• Overflow Incontinence

  No urinary retention or overflow. Cauda equina syndrome with retention or overflow incontinence. Incontinence at presentation is a poor prognostic sign. [aci.health.nsw.gov.au]

  – up to 92% (Korse 2017) Disruption of autonomic innervation leads to retention and overflow incontinence Bowel dysfunction (constipation and/or incontinence) – up to 74% (Korse 2017) Decreased sensation in the perianal area – up to 93% (Korse 2017) [rebelem.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]

  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]

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]

On the other hand, when acute aortic dissection is suspected, an emergent diagnostic workup should be initiated with ultrasound techniques involving either a transthoracic or transesophageal approach or computerized tomography. [intechopen.com]

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]

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]

Treatment The goal of treatment is to stop ongoing neurologic damage to the nerves of the cauda equina and minimize the risk of further difficulties. [nyp.org]

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]

[…] 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]

[…] 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]

Multiple etiologies can cause the cauda equina syndrome. [ncbi.nlm.nih.gov]

The data encountered in this study show that the main etiology found was disc herniation 69% (13), followed by tumor 16% (3), trauma 10% (2) and vascular 5% (1). Actually these etiologies somehow combine compressive and/or ischemic mechanisms. [scielo.br]

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]

Radiopaedia has images of cauda-equina cases caused by different etiologies. Cauda Equina Overview AAOS Cauda Equina page [aans.org]

The most likely etiology of her CES was direct damage secondary to the epidural needle puncture. [surgicalneurologyint.com]

Secondarily, this study will serve as a basis for other comparative studies aiming at a better understanding of this condition and its epidemiology. [scielo.br]

PMID: 16641784 Epidemiology of cauda equina and conus medullaris lesions. Podnar S. Podnar S. Muscle Nerve. 2007 Apr;35(4):529-31. doi: 10.1002/mus.20696. Muscle Nerve. 2007. [pubmed.ncbi.nlm.nih.gov]

[…] 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]

CES-I with its more favourable prognosis may become CES-R at a later stage. [22] Epidemiology [ edit ] The nerve roots extending from the lumbar spine are susceptible to compression, leading to CES. [en.wikipedia.org]

Epidemiological study of cauda equina syndrome. Acta Ortop Bras. [online]. 2013;21(3):159- 62. [Level Of Evidence: 4] ↑ Panos G. Et al. [physio-pedia.com]

Figure 3 : Axial MRI T2 at L3/L4 disc level depicting the exiting L3 nerve root with sacral roots lying posterior in canal Pathophysiology The pathophysiological mechanisms of CES are not completely understood. [oapublishinglondon.com]

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]

Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms Edited by Reinhart Grundmann Next chapter Anesthetic Management of Aortic Aneurysm By Zsófia Verzár and Sándor Szabados Related Book Etiology, Pathogenesis and Pathophysiology [intechopen.com]

Spinal Cord injury: Definition, Epidemiology, Pathophysiology by Segun T. Dawodu, M.D. [sci.rutgers.edu]

Pathoanatomy and pathophysiology of spinal nerve root compression. Spine. 1984;9(1):7–15. doi: 10.1097/00007632-198401000-00004. [PubMed] [CrossRef] [Google Scholar] 38. Rubinstein DJ, Alvarez O, Ghelman B, Marchisello P. [ncbi.nlm.nih.gov]

Use protective pads and pants to prevent leaks. [orthoinfo.aaos.org]

Drink plenty of fluids and use good personal hygiene to prevent urinary tract infections. Check for waste and clear the bowels with gloved hands. If needed, use glycerin suppositories or enemas. Wear protective pads and pants to prevent leaks. [webmd.com]