Back pain is a common complaint, but when it happens suddenly and also includes sudden numbness in the genital area, Difficulty urinating, y debilidad en las piernas – se trata de una emergencia médica.
Cauda equina syndrome is often caused by a large herniated disc in the lumbar region, that compresses the nerve roots at the end of the spinal cord
These nerves send messages to and from the bladder, intestines and legs. If they keep squeezed too long, irreversible damage may occur.
Immediate pressure relief surgery can prevent permanent damage and restore bladder and bowel function.
Index
What is cauda equina syndrome or cauda equina?
Cauda equina syndrome is a rare disease, but it has serious consequences if not treated quickly.
It is most often due to a large herniated disc in the lumbar region, compressing the nerve roots at the end of the spinal cord.
These nerve roots are grouped together and resemble a horse's tail.. This is how it gets its name. Cauda equina significa “cola de caballo” en latín.
Unlike most back problems that are long-standing or chronic, ponytail is an acute event, like a stroke or heart attack. It most often develops rapidly, within just 6 a 10 hours.
The classic symptoms are back pain, along with the sudden onset of numbness in the genital area and sudden urinary retention, are signs of a medical emergency.
Relieving compression quickly can determine whether the patient resumes a normal life or lives with incontinence and paralysis of the legs..
Less frequently, in people with recurrent back problems, ponytail may appear gradually, with a slow progression of urinary symptoms.
Because cauda equina syndrome is a disorder of the nerves that control the bladder, symptoms may be similar to those caused by bladder or prostate problems.
Cauda equina syndrome symptoms
Symptoms of cauda equina compression include bladder problems, bowel or sexual function, Difficulty urinating (retention) or trouble containing them (incontinence).
Most people have severe pain in the lower back and buttocks., así como entumecimiento y hormigueo en la “zona de la silla de montar” (rectal and genital areas and inner thighs).
Pain can travel down the back of the thigh, beyond knee, calf and foot (sciatica). An individual may experience weakness or paralysis in the leg or foot., especially when getting up from a chair.
Leg weakness and extreme loss of bladder or bowel function are signs of an emergency.; if this has happened, seek medical help immediately.
What are the causes?
A herniated disc can cause cauda equina syndrome. During a hernia, the gelatinous center of a spinal disc can protrude or break through a weak area in the wall of the disc and compress the nerves.
In most cases, herniated disc occurs at the L4-5 or L5-S1 discs in the lumbar spine. A sports injury, a fall or car accident can fracture the spine or tear a muscle and damage nerves.
Other causes include narrowing of the spinal canal. (stenosis), a tumor, an infection or bleeding.
How do you make the diagnostic?
A careful medical examination can confirm or rule out a suspected diagnosis of cauda equina.. The evaluation includes a medical history and physical exam. A loss of sensation in the anal area is a clear conclusion.
A patient complaining of severe leg weakness, numbness in the genital area, or loss of bladder or bowel function will undergo an MRI scan to reveal the degree to which the hernia is compressing the spinal nerves.
The doctor may also order a CT scan or myelogram..
Cauda equina syndrome surgical treatment
For a patient with acute equine tail syndrome, surgery likely urgently needed.
The goal is to relieve pressure on the spinal nerves to restore muscle function and bladder sensation., intestines and legs.
Depending on the cause, one of the following surgeries may be performed:
Discectomía
For one herniated disc removes the portion of the disc that is compressing the nerves. The surgeon makes a small incision in the center of the back.
The muscles of the spine moved to the side to expose the bony vertebra.
A window in the bone is removed to expose the nerve root and disc. The portion of the ruptured disc that compresses the spinal nerves is carefully removed.
Spinal decompression for stenosis:
Removes bone spurs and ligaments that compress the nerves. A small incision in the back.
The surgeon removes the bone that forms the roof of the spinal canal. Next, soft tissues and bone are removed to create more space for nerves.
Tumors and other lesions can also be removed.
Clinical trials
Los ensayos clínicos son estudios de investigación en el que los nuevos tratamientos – drogas, diagnostics, procedures and other therapies are tested in people to see if they are safe and effective.
Research is always carried out to improve the standard of medical care. Information on current clinical trials, including eligibility, protocol and places, are on the web.
Studies may be sponsored by the National Institutes of Health, as well as private industry and pharmaceutical companies.
Sequelae and postoperative cauda equina syndrome
Some bladder and bowel functions are automatic, but those under voluntary control can be lost if you have cauda equina syndrome.
This means that you may not know when you need to urinate or have a bowel movement., or you may have a hard time doing it.
Recovery from cauda equina syndrome depends on the severity of symptoms and the duration of the compressed nerves before surgery was performed.. The chance of full recovery for those with urinary retention is less [1,2]:
Of those who have experienced numbness and tingling in the genital area (CES incompleta), the 90% regained a normal bladder, the gut and sexual function.
Of people who suffer from bladder retention (CES completa), the 20% you may have permanent incontinence and loss of sensation in the pelvic area.
Residual problems after surgery may take a few months to resolve.. Rehabilitation methods may be necessary, like bladder retraining.
People who sustain permanent injuries will face challenges in their daily lives.. Physical Therapists Can Help You Learn Important Self-Care Skills, including self-catheterization, stress management and relaxation techniques.
Additional assistance can be provided by a social worker, a support group, a sex therapist or psychiatrist (for depression).
On rare occasions, leg paralysis may occur.