Cauda equina syndrome: Difference between revisions
(→Causes) |
|||
Line 66: | Line 66: | ||
The most common symptoms of cauda equina syndrome include | The most common symptoms of cauda equina syndrome include | ||
*Intermittent [[low back pain|Lower back pain]] radiating to the lower extremities. <ref name="pmid29432394">{{cite journal| author=Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T| title=Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review. | journal=Spine (Phila Pa 1976) | year= 2018 | volume= 43 | issue= 17 | pages= E1005-E1013 | pmid=29432394 | doi=10.1097/BRS.0000000000002605 | pmc=6104724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29432394 }} </ref><ref name="pmid32049799">{{cite journal| author=Luo D, Ji C, Xu H, Feng H, Zhang H, Li K| title=Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report. | journal=Medicine (Baltimore) | year= 2020 | volume= 99 | issue= 7 | pages= e19025 | pmid=32049799 | doi=10.1097/MD.0000000000019025 | pmc=7035013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32049799 }} </ref> | *Intermittent [[low back pain|Lower back pain]] radiating to the lower extremities. <ref name="pmid29432394">{{cite journal| author=Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T| title=Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review. | journal=Spine (Phila Pa 1976) | year= 2018 | volume= 43 | issue= 17 | pages= E1005-E1013 | pmid=29432394 | doi=10.1097/BRS.0000000000002605 | pmc=6104724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29432394 }} </ref><ref name="pmid32049799">{{cite journal| author=Luo D, Ji C, Xu H, Feng H, Zhang H, Li K| title=Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report. | journal=Medicine (Baltimore) | year= 2020 | volume= 99 | issue= 7 | pages= e19025 | pmid=32049799 | doi=10.1097/MD.0000000000019025 | pmc=7035013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32049799 }} </ref><ref name="pmid31335689">{{cite journal| author=Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T | display-authors=etal| title=Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report. | journal=Medicine (Baltimore) | year= 2019 | volume= 98 | issue= 29 | pages= e16396 | pmid=31335689 | doi=10.1097/MD.0000000000016396 | pmc=6709168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31335689 }} </ref> | ||
*Decreased [[Muscle weakness|muscle strength]] bilaterally.<ref name="pmid32049799">{{cite journal| author=Luo D, Ji C, Xu H, Feng H, Zhang H, Li K| title=Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report. | journal=Medicine (Baltimore) | year= 2020 | volume= 99 | issue= 7 | pages= e19025 | pmid=32049799 | doi=10.1097/MD.0000000000019025 | pmc=7035013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32049799 }} </ref><ref name="pmid29432394">{{cite journal| author=Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T| title=Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review. | journal=Spine (Phila Pa 1976) | year= 2018 | volume= 43 | issue= 17 | pages= E1005-E1013 | pmid=29432394 | doi=10.1097/BRS.0000000000002605 | pmc=6104724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29432394 }} </ref><ref name="pmid31335689">{{cite journal| author=Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T | display-authors=etal| title=Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report. | journal=Medicine (Baltimore) | year= 2019 | volume= 98 | issue= 29 | pages= e16396 | pmid=31335689 | doi=10.1097/MD.0000000000016396 | pmc=6709168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31335689 }} </ref> | |||
*[[Fecal incontinence]]/retention<ref name="pmid32049799">{{cite journal| author=Luo D, Ji C, Xu H, Feng H, Zhang H, Li K| title=Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report. | journal=Medicine (Baltimore) | year= 2020 | volume= 99 | issue= 7 | pages= e19025 | pmid=32049799 | doi=10.1097/MD.0000000000019025 | pmc=7035013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32049799 }} </ref><ref name="pmid29432394">{{cite journal| author=Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T| title=Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review. | journal=Spine (Phila Pa 1976) | year= 2018 | volume= 43 | issue= 17 | pages= E1005-E1013 | pmid=29432394 | doi=10.1097/BRS.0000000000002605 | pmc=6104724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29432394 }} </ref><ref name="pmid31847829">{{cite journal| author=Weng YC, Chin SC, Wu YY, Kuo HC| title=Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction. | journal=BMC Neurol | year= 2019 | volume= 19 | issue= 1 | pages= 328 | pmid=31847829 | doi=10.1186/s12883-019-1566-1 | pmc=6916224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31847829 }} </ref><ref name="pmid31335689">{{cite journal| author=Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T | display-authors=etal| title=Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report. | journal=Medicine (Baltimore) | year= 2019 | volume= 98 | issue= 29 | pages= e16396 | pmid=31335689 | doi=10.1097/MD.0000000000016396 | pmc=6709168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31335689 }} </ref> | |||
*[[Urinary incontinence]]/ [[urinary retention|retention]]<ref name="pmid31923259">{{cite journal| author=Srikandarajah N, Noble A, Clark S, Wilby M, Freeman BJC, Fehlings MG | display-authors=etal| title=Cauda Equina Syndrome Core Outcome Set (CESCOS): An international patient and healthcare professional consensus for research studies. | journal=PLoS One | year= 2020 | volume= 15 | issue= 1 | pages= e0225907 | pmid=31923259 | doi=10.1371/journal.pone.0225907 | pmc=6953762 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31923259 }} </ref><ref name="pmid32049799">{{cite journal| author=Luo D, Ji C, Xu H, Feng H, Zhang H, Li K| title=Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report. | journal=Medicine (Baltimore) | year= 2020 | volume= 99 | issue= 7 | pages= e19025 | pmid=32049799 | doi=10.1097/MD.0000000000019025 | pmc=7035013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32049799 }} </ref><ref name="pmid29432394">{{cite journal| author=Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T| title=Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review. | journal=Spine (Phila Pa 1976) | year= 2018 | volume= 43 | issue= 17 | pages= E1005-E1013 | pmid=29432394 | doi=10.1097/BRS.0000000000002605 | pmc=6104724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29432394 }} </ref><ref name="pmid31335689">{{cite journal| author=Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T | display-authors=etal| title=Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report. | journal=Medicine (Baltimore) | year= 2019 | volume= 98 | issue= 29 | pages= e16396 | pmid=31335689 | doi=10.1097/MD.0000000000016396 | pmc=6709168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31335689 }} </ref> | |||
* | *Unilateral or bilateral [[sciatica]]<ref name="pmid29432394">{{cite journal| author=Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T| title=Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review. | journal=Spine (Phila Pa 1976) | year= 2018 | volume= 43 | issue= 17 | pages= E1005-E1013 | pmid=29432394 | doi=10.1097/BRS.0000000000002605 | pmc=6104724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29432394 }} </ref><ref name="pmid31335689">{{cite journal| author=Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T | display-authors=etal| title=Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report. | journal=Medicine (Baltimore) | year= 2019 | volume= 98 | issue= 29 | pages= e16396 | pmid=31335689 | doi=10.1097/MD.0000000000016396 | pmc=6709168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31335689 }} </ref> | ||
*[[Saddle anesthesia]]<ref name="pmid29432394">{{cite journal| author=Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T| title=Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review. | journal=Spine (Phila Pa 1976) | year= 2018 | volume= 43 | issue= 17 | pages= E1005-E1013 | pmid=29432394 | doi=10.1097/BRS.0000000000002605 | pmc=6104724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29432394 }} </ref><ref name="pmid31335689">{{cite journal| author=Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T | display-authors=etal| title=Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report. | journal=Medicine (Baltimore) | year= 2019 | volume= 98 | issue= 29 | pages= e16396 | pmid=31335689 | doi=10.1097/MD.0000000000016396 | pmc=6709168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31335689 }} </ref> | |||
*[[Paraplegia|Paraparesis]]<ref name="pmid31847829">{{cite journal| author=Weng YC, Chin SC, Wu YY, Kuo HC| title=Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction. | journal=BMC Neurol | year= 2019 | volume= 19 | issue= 1 | pages= 328 | pmid=31847829 | doi=10.1186/s12883-019-1566-1 | pmc=6916224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31847829 }} </ref> | *[[Paraplegia|Paraparesis]]<ref name="pmid31847829">{{cite journal| author=Weng YC, Chin SC, Wu YY, Kuo HC| title=Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction. | journal=BMC Neurol | year= 2019 | volume= 19 | issue= 1 | pages= 328 | pmid=31847829 | doi=10.1186/s12883-019-1566-1 | pmc=6916224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31847829 }} </ref> | ||
*[[Erectile dysfunction]]<ref name="pmid31847829">{{cite journal| author=Weng YC, Chin SC, Wu YY, Kuo HC| title=Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction. | journal=BMC Neurol | year= 2019 | volume= 19 | issue= 1 | pages= 328 | pmid=31847829 | doi=10.1186/s12883-019-1566-1 | pmc=6916224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31847829 }} </ref> | *[[Erectile dysfunction]]<ref name="pmid31847829">{{cite journal| author=Weng YC, Chin SC, Wu YY, Kuo HC| title=Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction. | journal=BMC Neurol | year= 2019 | volume= 19 | issue= 1 | pages= 328 | pmid=31847829 | doi=10.1186/s12883-019-1566-1 | pmc=6916224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31847829 }} </ref> | ||
Line 109: | Line 109: | ||
==Treatment== | ==Treatment== | ||
'''Medical Treatment''' | '''Medical Treatment''' | ||
Cauda equina syndrome is a medical emergency and requires prompt treatment. Although the mainstay of treatment is surgery, The following medications are used. | |||
*5.4 mg/kg·h of methylprednisolone (intravenous) for 2 days | |||
*5 mg of dexamethasone (intravenous) every 12 h for 3 days | |||
*0.5 mg of mecobalamin tablets (oral) every 8 h | |||
'''Surgery''' | '''Surgery''' |
Revision as of 22:31, 14 July 2020
Cauda equina syndrome | ||
Cauda equina and filum terminale seen from behind. | ||
ICD-10 | G83.4 | |
ICD-9 | 344.6 | |
DiseasesDB | 31115 | |
MeSH | C10.668.829.800.750.700 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]
Overview
The cauda equina is a collection of nerves at the end of the spinal cord. Cauda equina syndrome is due to compression of these nerves. It is an emergency medical condition requiring acute intervention in the form of acute decompression surgery to prevent permanent neurological damage to the urinary bladder, Intestine, sex organs and lower limbs.
Historical perspective
Classification
Cauda equina syndrome may be classified into complete and incomplete.[1][2]
- Cauda equina complete with urinary retention
- Cauda equina syndrome incomplete
Cauda equina syndrome | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Complete with urinary retention | Incomplete | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Lumbar +/- leg pain, sensory and motor deficency in lower extremities, painless urine retention with overflow incontinence, total perianal sensory loss, and fecal incontinece. | Lumbar +/- leg pain, sensory and motor deficency in lower extremities, loss of micturition reflex, altered urinary sensation and hesitancy, partial saddle anesthesia, and decreased anal sphinter tone. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathophysiology
Cauda equina syndrome is caused by compression of the lumbar and sacral nerves roots arising below the conus medullaris.[2]
Causes
Cauda equina syndrome may be caused by[3]
- Lumbar disc herniation[3]
- conus medullaris infarction[4]
- Lumbar spinal stenosis[5]
- Vertebrae fracture
Differentiating cauda equina syndrome from other Diseases
Cauda equina syndrome must be differentiated from spinal disc herniation, epidural hematoma, spinal tumor, spinal stenosis, and diabetic amyotrophy.
Epidemiology and Demographics
The incidence of cauda equina syndrome is 2 per 100,000 world wide.[1]
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
The most common symptoms of cauda equina syndrome include
- Intermittent Lower back pain radiating to the lower extremities. [2][3][5]
- Decreased muscle strength bilaterally.[3][2][5]
- Fecal incontinence/retention[3][2][4][5]
- Urinary incontinence/ retention[1][3][2][5]
- Unilateral or bilateral sciatica[2][5]
- Saddle anesthesia[2][5]
- Paraparesis[4]
- Erectile dysfunction[4]
Physical Examination
- Hypesthesia[3][4]
- Saddle dysesthesia[4]
- Lasegue sign[3]
- Decreased knee and ankle reflex bilaterally. [3][4]
- Asymmetric calf wasting[4]
- Lower limb weakness[4]
- Positive Babinski sign[4]
- Impaired proprioception[4]
Laboratory findinds
X-ray
Ultrasound
CT Scan
Lumbosacral CT scan may be helpful in the diagnosis of cauda equina syndrome. Findings on CT scan suggestive of/diagnostic of cauda equina syndrome include
- CT scans show herniated nucleus pulposus at the L4/5 level.
MRI
Lumbosacral MRI may be helpful in the diagnosis of cauda equina syndrome.[3][2] Findings on MRI suggestive of/diagnostic of cauda equina syndrome include
- In Lumbar disc herniation, MRI shows a disc mass filling most of the spinal canal compressing the cauda equina.
Other Imaging Findings
Other Diagnostic Findings
Treatment
Medical Treatment Cauda equina syndrome is a medical emergency and requires prompt treatment. Although the mainstay of treatment is surgery, The following medications are used.
- 5.4 mg/kg·h of methylprednisolone (intravenous) for 2 days
- 5 mg of dexamethasone (intravenous) every 12 h for 3 days
- 0.5 mg of mecobalamin tablets (oral) every 8 h
Surgery
Surgery is the mainstay of treatment for cauda equina syndrome.[2][3] Procedures used include
- Laminectomy and discectomy (most common)
- Hemilaminectomy
- Transforaminal lumbar interbody infusion
- Microdiscectomy
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 1.2 Srikandarajah N, Noble A, Clark S, Wilby M, Freeman BJC, Fehlings MG; et al. (2020). "Cauda Equina Syndrome Core Outcome Set (CESCOS): An international patient and healthcare professional consensus for research studies". PLoS One. 15 (1): e0225907. doi:10.1371/journal.pone.0225907. PMC 6953762 Check
|pmc=
value (help). PMID 31923259. - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T (2018). "Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review". Spine (Phila Pa 1976). 43 (17): E1005–E1013. doi:10.1097/BRS.0000000000002605. PMC 6104724. PMID 29432394.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Luo D, Ji C, Xu H, Feng H, Zhang H, Li K (2020). "Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report". Medicine (Baltimore). 99 (7): e19025. doi:10.1097/MD.0000000000019025. PMC 7035013 Check
|pmc=
value (help). PMID 32049799 Check|pmid=
value (help). - ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 Weng YC, Chin SC, Wu YY, Kuo HC (2019). "Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction". BMC Neurol. 19 (1): 328. doi:10.1186/s12883-019-1566-1. PMC 6916224 Check
|pmc=
value (help). PMID 31847829. - ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Yuan T, Zhang J, Yang L, Wu J, Tian H, Wan T; et al. (2019). "Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery: A case report". Medicine (Baltimore). 98 (29): e16396. doi:10.1097/MD.0000000000016396. PMC 6709168 Check
|pmc=
value (help). PMID 31335689.
Template:Neuroscience-stub Template:Cerebral palsy and other paralytic syndromes [{Category:Needs patient information]] de:Cauda-equina-Syndrom