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Cauda Equina Syndrome (CES)

The most common cause of it is Disc herniation at L4/5 or L5/S1 levels. Other causes include Tumour, Abscess, Trauma.


The cauda equina supplies:

  • Sensation to Perineum, Bladder, Rectum

  • Motor to Anal & Urethral sphincters, and lower limbs

  • Parasympathetic to Bladder and Rectum

Presentation

The key presenting symptoms are:

  • Lower back pain

  • Saddle anaesthesia - "Does it feel normal when you wipe after opening your bowels?"

  • Bilateral sciatica

  • Bowel/bladder disturbance


Other clinical features may include:

  • Leg weakness

  • Sexual dysfunction

  • Loss of anal tone on DRE


Investigations and Management

  • Whole spine MRI

  • Lumbar decompression

  • If malignancy is suspected or seen on MRI, manage as per MSCC guidelines i.e. give 16 mg IV Dexamethasone (with PPI cover)

“MRI of the lumbar spine of a A 57-year-old woman: The collection in the posterior epidural space and the posterior disc bulge is seen compressing the thecal sac and the cauda equina” © Jing Jing Chan and Jen Jen Oh CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

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