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]

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]

Presented at the annual meeting of the New England Surgical Society, New Haven, Connecticut, October 1, 1948. [nejm.org]

• 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]

• Intravenous Drugs

  Past medical history History of intravenous drug use (increases risk of epidural abscess) Previous spinal surgery or arthritis Metabolic bone disease impacts treatment options Osteoporosis; Vit D deficiency; hyperparathyroidism Medications & allergies [oxfordmedicaleducation.com]

• 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]

  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]

  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]

• 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]

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

  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]

• Acute Low Back Pain

  Cauda Equina syndrome is a neurological emergency that usually presents with acute low back pain, sciatica in one or both legs, and may suddenly or progressively cause numbness or paresthesia in the perianal area. [hayneslawyers.com]

  Where this is unavailable a CT scan should be performed ( see acute low back pain - investigations ) Routine pre-operative blood tests and investigations (e.g. ECG) should be taken including coagulation studies and a blood group and hold. [aci.health.nsw.gov.au]

• Hip Pain

  CASE REPORTS Case report 1 A 59-year-old male [height 6', weight 250 lbs (113.4 kg); body mass index (BMI) 33.91 kg/m 2 ] presented with a 2-year history of groin and left hip pain without radicular symptoms [ Table 1 ]. [surgicalneurologyint.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]

  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]

  incontinence or dysfunction and progressive weakness in the legs and/or feet Gradual onset CES: The symptoms of gradual onset usually include recurring back pain associated with muscle weakness and numbness, and urinary incontinence or dysfunction Individuals [dovemed.com]

  Medical conditions, medications, and urinary incontinence. analysis of a population-based survey. Can Fam Physician. 2002; 48 :96–101. [aliem.com]

  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]

  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]

  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]

  Patients have a complete cauda equina syndrome when the bladder becomes paralysed and this leads to painless retention of urine with overflow incontinence. [ncbi.nlm.nih.gov]

• 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]

• Urinary Urgency

  Typically, people who have suffered with cauda equina syndrome are left with a urinary urgency or even full incontinence, a difficulty to distinguish between flatulence and the need to pass a bowel motion, and even more concerning, symptoms of numbness [claims-medneg.co.uk]

• 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]

  The first, Dissatisfaction with care: ‘ I felt very abandoned ’, captured experiences of feeling neglected and disbelieved by the healthcare system and a wish for symptoms to be validated. The second, Hidden to others: ‘ Nobody knows. [nature.com]

  DISCUSSION CES still remains a disease that is often neglected in emergency services, which entails considerable social and financial costs. [scielo.br]

• Myelopathy

  Radiation-induced myelopathy Type 1 Excludes myelopathy NOS ( G95.9 ) G95.89 ) neurogenic bladder NOS ( ICD-10-CM Diagnosis Code N31.9 Neuromuscular dysfunction of bladder, unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable To Neurogenic [icd10data.com]

  […] void residual) Saddle anesthesia: Reduced or absent sensation in the perineal area (S2-S4 innervation) Decreased or absent rectal tone Differential Diagnosis (non-compressive causes of spinal cord dysfunction) Multiple Sclerosis Transverse Myelitis Myelopathies [rebelem.com]

  External links [ edit ] 06-093c. at Merck Manual of Diagnosis and Therapy Home Edition Cauda_equina_syndrome at the Duke University Health System 's Orthopedics program v t e Lesions of spinal cord and brain Spinal cord / vascular myelopathy sensory: [en.wikipedia.org]

• Foot Drop

  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]

  The feet may not “work right” and may slap on the ground when walking (foot drop). Problems with bowel and bladder function. The patient might find it difficult to start (initiate) urination. [neckandback.com]

  There may be "foot drop" where the foot drags and causes trips and falls. In some cases it may be necessary to use walking aids or a wheelchair. [caudaequina.org]

  The person may experience, 'foot drop,' where their foot drags and may cause trips and falls. In some instances, it may be necessary for the person to use walking aids or a wheelchair. [disabled-world.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]

• 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]

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]

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]

Prognosis The evidence also remains weak for symptom duration before surgery and functional recovery. [oapublishinglondon.com]

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]

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]

CAUDA EQUINA SYNDROME • Etiologies • Disc herniation • Disc fragment migration • Iatrogenic epidural hematoma • Post LP or spinal anesthesia • Postoperatively • Infection • Tumor • Trauma 13. [slideshare.net]

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]

[…] 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]

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]

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]

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]

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]