Is Cauda Equina Syndrome a Surgical Emergency?
Back pain is never pleasant, but most of the time, it’s not a medical emergency. In some cases, though, back pain is a sign of a serious problem—and if it’s not addressed promptly through surgery, it could result in permanent disability. One such situation is when a patient has cauda equina syndrome (CES).
The bundle of nerves at the very bottom of the spinal cord bear a resemblance to a horse’s tail—or in Latin, “cauda equina.” When the roots of these nerves are compressed, usually, by a ruptured lumbar disk but sometimes by stenosis (narrowing) of the spinal canal, lower back pain and other symptoms can result.
Lower back pain has a variety of causes, and cauda equina syndrome (CES) is far from the most common. There is a saying among doctors: “When you hear hoofbeats, think horses, not zebras.” In other words, it’s more likely that a concerning symptom is caused by a common ailment rather than a rare one. As a general rule, that is accurate, and if mild lower back pain is a patient’s only symptom, there is no reason to immediately suspect CES.
If certain other symptoms are present, however, a treating physician should err on the side of caution and screen further for the possibility of CES. The failure to promptly identify and treat CES can have devastating effects on a patient’s future.
Incidence, Causes, and Symptoms of Cauda Equina Syndrome
As noted, cauda equina syndrome is uncommon: estimates place the incidence at anywhere from 1 in 33,000 to 1 in 100,000 in the general population. Because the diagnosis is not common and the most typical symptom is lower back pain, it makes sense that doctors don’t immediately assume CES when a patient presents with severe lower back pain.
Other common symptoms of CES include:
- “Saddle anaesthesia;” numbness in the inner thighs, rectal area, and genital area; in other words, the body parts that would sit in a saddle
- Recent-onset bladder abnormalities (either retaining urine or incontinence)
- Recent-onset bowel incontinence
- Recent-onset sexual dysfunction
- Motor weakness, loss of sensation, or pain in one, or more typically, both legs
- Recent-onset sexual dysfunction
- Reflex loss in extremities
- Sensory changes in the rectum or bladder
One or more of these symptoms, coupled with the severe lower back pain that is typical in CES, should encourage a doctor to set up immediate screening for the condition. There are other conditions, such as peripheral nerve disorder or spinal cord compression, that can also feature these symptoms.
The most common cause of CES is a herniated lumbar disc. Other causes include:
- Stenosis (narrowing) of the lumbar spine
- Violent injury to the lumbar spine, such as from a car accident or gunshot
- Postoperative complications from lumbar spine surgery
- Spinal tumors or lesions
- Spinal infection
- Spinal inflammation
- Spinal hemorrhages
- Spinal anaesthesia
- Congenital spinal abnormalities
A thorough history and physical will paint a picture that should at least raise the prospect of CES in a doctor’s mind. If a patient has recently had spinal surgery, suffered a sudden severe injury to the spine, or had cancer or a severe infection, CES should move onto the doctor’s radar screen.
With some medical conditions, even when they cause severe pain, the prudent course of action is to wait and observe to see if the patient’s condition approves. Taking this approach with cauda equina syndrome could lead to permanent and severe disability. Cauda equina syndrome is a surgical emergency, and prospects for recovery are best if the patient’s condition is diagnosed promptly and he or she undergoes surgery within 48 hours after the onset of symptoms.
Diagnosis and Treatment of Cauda Equina Syndrome
If a patient’s symptoms and medical history suggest that cauda equina syndrome is a possibility, magnetic resonance imaging, or MRI, should be administered. MRIs use magnets and radio waves to create detailed three dimensional images of the inside of a patient’s body. Unlike a CT scan, an MRI does not use radiation.
Another test commonly used in the diagnosis of CES is a myelogram. In this procedure, contrast material is injected into the body and an X-ray of the spinal canal is performed. This procedure can show whether spinal nerves or the spinal cord have suffered displacement from a herniated disc or a tumor.
As with many conditions involving nerve injury, the sooner the condition is identified and treated, the better the prognosis. Surgery can relieve pressure on the nerves of the spine, allowing sensation to return and function to improve. Depending on the issue causing the condition, a discectomy or spinal decompression may be called for. Discectomy removes the portion of a herniated spinal disc that is causing the nerves to compress. Spinal decompression is a surgical procedure that treats spinal stenosis (narrowing) due to bone spurs or other causes.
Because permanent loss of sensation and function can result from delay in diagnosis and treatment, failure to timely diagnose cauda equina syndrome may be medical malpractice. If you or a loved one have suffered injury as a result of a doctor’s failure to promptly treat CES, we invite you to contact Huegli Fraser today to schedule a consultation.
The information in this blog post is provided for informational purposes only and is not intended to be legal advice. You should not make a decision whether or not to contact a qualified medical malpractice attorney based upon the information in this blog post. No attorney-client relationship is formed nor should any such relationship be implied. If you require legal advice, please consult with a competent medical malpractice attorney licensed to practice in your jurisdiction.