cauda equina syndrome

Headline
Etiology L4/L5 or L5/S1 disc herniation. Tumour, trauma, abscesses are rare.
Epidemiology
Clinical presentation GIRFT says:
- <14 days/deteriorating:
- impaired sensation of urine flow
- initiating micturition
- <14 days/deteriorating:
- perineal/perianal/genital sensation
- Severe or progressive neurological deficit (major motor weakness) of both legs
- New (≤ 14 days) or deteriorating loss of sensation of rectal fullness
- New (≤ 14 days) or deteriorating sexual dysfunction (achievement of erection or ability to ejaculate, loss of genital sensation)

OR
- Sudden onset bilateral radicular pain
- Unilateral radicular leg pain that has progressed to bilateral
- >14 days altered perineal etc. sensation; altered sensation of urinary flow; loss of sensation of rectal fullness; sexual dysfunction/loss of genital sensation that is deteriorating
Pathogenesis
Diagnostic investigations Pre- and post-void bladder scan is part of GIRFT → catheterise if >600ml and document catheter tug (>200ml post void is sensitive for CES)
MRI whole spine
Management Initial management:
Catheterise

Definitive
Transfer to spinal surgery by Cat 2 (if applicable) for surgical decompression

#orthopaedics #surgical

https://girft-interactivepathways.org.uk/cauda-equina-1/

  • <14 days/deteriorating:
    • impaired sensation of urine flow
    • initiating micturition
  • <14 days/deteriorating:
    • perineal/perianal/genital sensation
  • Severe or progressive neurological deficit (major motor weakness) of both legs
  • New (≤ 14 days) or deteriorating loss of sensation of rectal fullness
  • New (≤ 14 days) or deteriorating sexual dysfunction (achievement of erection or ability to ejaculate, loss of genital sensation)