Cauda equina syndrome: symptoms, what causes?

Cauda equina syndrome gets its name from the conical shape of the spinal nerves at the base of the spineWho looks like a ponytail. This compression can cause a series of serious symptoms. Several treatment options are possible, including surgery. Explanations with Romain Rodicq, physiotherapist.

What is this syndrome?

“Cauda Equina Syndrome (CQS) occurs when nerve roots located below the terminal cone of the spinal cord at the level of the lumbar spine (between L2 and the sacrum) are compressed“, explains Romain Rodicq. “VSThis syndrome is rare but it is important to recognize the condition, because it constitutes a medical emergency.” Indeed, without rapid surgical treatment, symptoms can become permanent and have significant repercussions on patients’ quality of life. “The motor and sensory function of the perineum, bladder, intestines, as well as the lower limbs, can be affected.”

“One of most common causes of cauda equina syndrome is the disc herniation excludedcontinues Romain Rodicq. This is the case when the gelatinous material inside an intervertebral disc comes out from its place and presses on the nerve roots of the ponytail.”

► Spinal tumors. Bone tumors or nervous system tumors like paraganglioma can grow in the spine and put pressure on the cauda equina nerves.

► Certain spinal infections (such as spondylodiscitis) can cause inflammation and compression of the cauda equina nerves.

► Serious spinal injuriessuch as fractures, can damage the cauda equina nerves and lead to the syndrome.

What symptoms?

“Symptoms may vary depending on the anatomy and severity of nerve compression,” specifies our interlocutor. One of the main symptoms is the decrease or loss of sensitivity, especially in the legs. “Nerve compression can lead to muscle weakness, especially in the leg and foot muscles. This may affect the ability to walk.” Depending on the severity of the syndrome, cauda equina syndrome can cause urination and intestinal problems (constipation). “Sensory symptoms can be an alert. But motor symptoms are a medical emergency. The MRI will confirm the diagnosis and will exclude for example sciatica (linked exclusively to a herniated disc).”

What disability?

Cauda equina syndrome is a serious medical condition which can have significant consequences on a person’s functionality and quality of lifee. “The extent of the disability depends on various factors, such as the severity of the nerve compression, how quickly the condition is diagnosed and treated, and the individual response to treatment.” explains Romain Rodicq.

Risks of permanent after-effects.

In case of severe nerve compression of the ponytail and in the absence of rapid medical intervention, the risk of disability may increase. “Symptoms such as loss of sensation, muscle weakness, bladder control problems, as well as sexual difficulties, can lead to significant impairment of mobility and ability to perform daily activities.” Surgical intervention is often necessary to relieve nerve compression. “However, even with appropriate treatment, recovery can be variable, and some people may experience permanent aftereffects.”

What treatments to cure?

Treatment for cauda equina syndrome depends on the underlying cause of the nerve compression (trauma, herniated disc, tumors, infections, etc.) and the severity of the symptoms. The treatment aims to relieve pressure on nerves of the ponytail and prevent permanent after-effects. “For example, in the most common case of a herniated disc that compresses the nerves of the cauda equina, a surgical intervention is essential to relieve nerve compression, continues Romain Rodicq. A surgical excision is performed to remove the herniated disc. The process is the same in the case of a tumor. Sometimes, when excision is not possible, a arthrodesis (fixation of two vertebrae) is performed.”

► medications may be prescribed to relieve pain and reduce inflammation. Pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used.

► A antibiotic therapy may be prescribed in the event of an infectious cause.

► A radiotherapy or chemotherapy is necessary when the tumor causing cauda equina syndrome is surgically inaccessible.

► Physiotherapy can play an important role in the management of symptoms of cauda equina syndrome. “We often intervene in addition to surgery in order to help restore muscle strength of the patient, to improve their coordination and to facilitate their functional recovery. Thanks to exerciseswe will be able to readi restore strength in the legs, help him improve stability, regain sensitivity, or strengthen your abdominal belt.” It is important that physiotherapy is integrated into an overall treatment plan supervised by a multidisciplinary medical team (neurologist, spinal surgeon, occupational therapist, etc.).

“Recovery depends in particular on nerve compression, replies the physiotherapist. The longer the nerve compression has been prolonged, the greater the damage may be, which may affect recovery.” The severity of symptoms at the time of diagnosis, as well as the success of surgery, may also play a role in recovery.. “Successful decompression of the nerves is crucial.” The implementation of rehabilitation programs can positively influence functional recovery. “Just after the operation, the physiotherapist will come and re-stimulate the patient’s lower limbs. Once discharged, he will be able to come to the office, 2 to 3 times a week, to do exercises in order to regain strength, mobility and sensitivity .”

Thanks to Romain Rodicq, physiotherapist/osteopath in Noisy-le-Roi (78)