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CAUDA EQUINA SYNDROME, Based on: Uncovering cauda equina Kate Woodrow …
CAUDA EQUINA
SYNDROME
ANATOMY
Bundle of
intramural nerve roots
distal to conus medullaris
extend towards coccyx
L2
Motor
hip flexors
thigh adductors
Sensory
upper thigh
L3
Motor
Quadriceps
knee extensors
Sensory
anterolateral thigh
Reflexes
patella
knee
L4
Motor
knee extensors
foot dorsiflexors
Sensory
anteromedial calf
L5
Motor
foot & toe
dorsiflexors flexors
extensor hallucis longus
Sensory
lateral calf
dorsum of foot
S1, 2
Motor
foot & toe
plantar flexors
Sensory
lateral side of foot
sole of foot
Reflexes
ankle
S2, S3,
S4, S5
Motor
sphincters
Sensory
perianal
saddle
Reflexes
bulbocavernosus
RED FLAGS
Severe low back pain
Sciatica - often bilateral
Saddle / genital sensory disturbance
Bladder, bowel & sexual dysfunction
DEFINITION
5 characteristics
Bilateral neurogenic sciatica
reduced perineal/saddle sensation
altered bladder function
including painless retention
loss of anal tone
loss of sexual function
Rare
1:33 000 - 100 000
Surgery 2010-11
800
DIAGNOSIS
severe bilateral sciatica
some or all red flags
refer to A&E
Treatment
MRI imaging
Surgery ASAP
Differential
Diagnosis
Radiculopathy
lumbar-sacral compression
L1 - S4
Conus medullaris syndrome
T12 - L2 compression
Mechanical back pain
Disc herniation
Lumbar stenosis
60+ usually
Spondylolisthesis
vertebral body slippage
ageing process
Spinal cord syndrome
covers a varitey of syndromes
Other causes
see aetiology
& also consider
diabetes mellitus
multiple sclerosis
benign prostatic hyperplasia
AETIOLOGY
Congenital
spinal dysraphism
dwarfing syndrome
congenital tumors:-
demoid
epidermoid
teratoma
lipoma
Infective
bacterial abcess
tuberculosis
schistosomiasis
Traumatic
spinal fractures
dislocations
Vascular
arteriovenous malformations
aortic dissection
Latrogenic
surgery of spine
anaesthesia spine/epidural
spinal manipulation
Neoplastic
ependymoma
neurofibroma
meningioma
schwannoma
lymphoma
metastases
Endocinre
osteoporotic collapse
Biochemical
Paget's disease
Inflammatory
rheumatoid arthritis
ankylosing spondylitis
Haemorrahage epidural
subdural haematoma
Thromotic
inferior vena cava
thrombosis
TIPS
for non-specialists
Be alert
new symptoms changes
perianal
bladder
increase back pain
increase sciatica
Be aware
insidious
chronic back & leg pain
plus bladder symptoms
Most appropriate
channel for referral
& further investigation
Clinical documentation
clear
complete
Based on:
Uncovering cauda equina
Kate Woodrow
The Podiatrist Jan/Feb 2021 Vol 24/1