Afternoon D & C Dedicated To Mumbai
Home > Health & Fitness > Get to the root of CES

Get to the root of CES

Tuesday, October 02, 2018

A rare horse tail syndrome can lead to a series of neurological disorders, says Dr Arvind G Kulkarni

The cauda equina syndrome (CES)

CES is a serious type of nerve root problem where there is a pressure on the nerves at the very bottom of the spinal cord. The nerves at the base of the spinal cord are squeezed that causes pain in the lower back and/or legs, numbness or weakness in one or both legs, in the buttocks or between the legs. The cauda equina is called horse tail because the collection of nerves at the bottom of the spinal cord looks the same as a volumised horse tail.

 Though CES is rare, it is a severe neurological disorder that can lead to incontinence or even paraplegia if left untreated. 

CES commonly results in low back pain, problems with bowel and bladder function (not able to pass urine), weakness in legs and numbness in the saddle area. CES needs urgent treatment and investigation to prevent the nerves of the bladder and bowel from becoming permanently damaged.

What the nerves do

Nerves act differently in the whole body. Some join to form the sciatic nerves and some provide the sensation and control for the bladder, anal and genital regions.

The cauda equina is behind the lumbar discs, in the spinal canal. The lumbar discs sit between the vertebrae but they rupture sometimes (which is known as slipped disc). And this happens suddenly usually in the younger people. This rupture makes the nerves of caudal equine trapped and squeezed.  Older people face this problem due to arthritic changes within the spine.

Causes of CES

Trauma It can lead to fracture or dislocation of the lower back that can result in compression of caudal equina. Collection of blood in the nerves, gunshots or stab wounds, partial dislocation can damage or compression can cause cauda equina syndrome.

Herniated Disk Seventy five percent cases of herniated disk leads to caudal equine syndrome in people with the history of chronic lower back pain and some even develop caudal equine syndrome as the first symptom of lumbar disk herniation. Males aged between 30-40 are prone to caudal equine syndrome caused by herniated disk.

Spinal Stenosis This term can be explained as the narrow distance of the front and back of the spinal canal. The abnormal narrowing of the spinal canal is due to the developmental abnormality or degenerative process and is called spondylolisthesis. The severe cases lead to caudal equine.

Tumours CES syndrome can be caused by isolated tumours or tumours that have spread to the spine from other parts of the body. The initial symptom caused by a tumour is severe low back and leg pain.

Infectious Conditions Infections can cause deformity of the nerve roots and spinal column in the spinal canal.

Inflammatory Conditions

Spondylitis and Paget’s disease can lead to narrowing of the spinal canal and lead to cauda equina syndrome.

CES Symptoms

Low back pain

Sciatica

Numbness in the groin or area of contact if sitting on a saddle

Bowel and bladder disturbances

Lower extremity muscle weakness and loss of sensations

Leg pain

Inability to urinate

Decreased sensation while urinating

Inability to stop or control urination

Constipation

Medical care and treatment

This syndrome is a surgical emergency. The patient should immediately seek medical emergency treatment if the doctor detects the symptoms of CES. The initial

symptoms, such as low back pain and muscle weakness, are often caused by disk herniation which doesn't require urgent attention but if the symptoms increase to develop severe pain or loss of sensation, bowel or bladder disturbance then immediate medical attention is required.

 The initial diagnosis is based on the findings from patients’ history, symptoms and physical exam. The tests include muscle strength testing, evaluating sensation to touch and pain, sensation and reflex.

X-rays and MRIs help in diagnosis of evidence of trauma, severe arthritis, tumours, infection, intervertebral disks, and nerve roots. It is a most important study required to diagnose if the nerves are being compressed, to what degree, and by what structures.

These studies help the doctor or surgeon to plan the appropriate treatment. The medical treatment options are useful in certain cases and the underlying cause of the CES.

In the inflammatory cases, anti-inflammatory agents and corticosteroids are effective. CES caused by an infection should receive appropriate antibiotic therapy. Patients with spinal tumours should be evaluated for chemotherapy and radiation therapy.

 Patients having symptoms of groin numbness or weakness or loss of bowel or bladder control should not wait for more than 24 hours for medical help. If there is no relief after initial treatment, immediate surgical decompression is often recommended to minimise the chances of permanent nerve injury.

 The emergency decompression of the spinal canal is the best treatment option for this syndrome. The motive is to relieve pressure on the nerves of the cauda equina by removing the compressing structures and increasing the space available for the nerves in the spinal canal.

CES is considered as a  surgical emergency, with surgical decompression considered necessary within 48 hours of the onset of symptoms.

People having herniated disk as a cause of CES are advised to remove the portion of the bone surrounding the nerves.

Dr Arvind G Kulkarni is Head of Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital

Short Takes

The cauda equina syndrome commonly results in low back pain, problems with bowel and bladder function, weakness in legs and numbness in the saddle area. CES needs urgent treatment and investigation to prevent the nerves of the bladder and bowel from becoming permanently damaged.

Though CES is rare, it is a severe neurological disorder that can lead to incontinence or even paraplegia if left untreated.

COMMENTS
No Comments Posted
POST YOUR COMMENTS
Name:  
 
Email:    
Comments:
 
 
City news
As part of the campaign, officers of respective ...
A spate of arson-related incidents continued as m
Nearly 30 million premature babies need specializ
Is it safe to have intercourse during the menses?
Dr. Rajan B. Bhonsle, M.D. (Bom)
Consulting Sex Therapist & Counsellor
Dr. (Mrs.) Minnu R. Bhonsle, Ph.D.
Consulting Psychotherapist & Counsellor
Astrology
Select Sun sign:
 
Aries (Mar 21 - Apr 20)
Aries (Mar 21 - Apr 20)Today you will feel like going green, and Ganesha approves. You could plant a sapling, or organise some dustbins to keep the neighbourhood clean. If you wish to make the world a better place to live in, do it but take it step by step.
- Advertising -
Read More