What Causes Cauda Equina Syndrome?

Spine-lumbar vertebrae highlighted

Cauda equina is a disorder that affects the bundle of nerve roots at the lumbar end of the spinal cords. This bundle resembles a horse’s tail; the Latin for horse’s tail, “cauda equina” gives the disorder its name. The cauda equina affects one’s legs, bladder, and sexual function. The nerve roots in the cauda equina send messages to and from the brain to the legs and pelvic organs, allowing things we often take for granted, such as walking and going to the bathroom.

But when those messages are disrupted by a compression of the nerves, a variety of unpleasant symptoms can arise: incontinence, loss of sexual function, even paralysis. What’s more, if cauda equina syndrome is not quickly diagnosed and treated, those problems can become permanent. Even with swift treatment, a full recovery is not guaranteed. But it is clear that the sooner this condition is treated, the better the outcome will be for the patient.

Too often, the diagnosis of cauda equina syndrome happens later than it should, sometimes because doctors neglect to identify “red flags” of the disorder. This failure may be medical malpractice and can lead to serious and lifelong limitations for a patient.

Most Common Causes of Cauda Equina Syndrome

A herniated lumbar disk is the most common cause of cauda equina syndrome (CES). Even so, only about 2% of herniated lumbar disks will lead to CES. The lumbar spine is your lower back region, Even though the odds are against you developing CES even if you have a herniated lumbar disk, you should still be aware of the symptoms of CES so that you can seek treatment promptly if they appear.

Unlike many spinal problems, which may develop over the course of weeks, months, or even many years, cauda equina syndrome can have a rapid onset. Acute cauda equina syndrome can develop in as little as 6-10 hours. You should never ignore the symptoms of CES, which include:

  • Numbness or odd sensations in the “saddle region:” inner thighs, buttocks, backs of legs—in other words, the parts of your body that would be in contact with a saddle if you were riding a horse
  • Sciatica-type pain in your back or legs
  • Urinary retention: difficulty initiating a stream of urine
  • Urinary or fecal incontinence: difficulty controlling the release of urine or feces
  • Sexual dysfunction
  • Weakness in the lower extremities
  • Paralysis of the lower extremities.

In addition to the red flags listed above, if you have cauda equina syndrome you may experience paresthesia (tingling or burning in the lower extremities), problems with your reflexes, or pain in your lower back. Seek emergency medical care if these symptoms develop, especially if they have a rapid onset.

While a herniated disk in the lumbar region is the most common cause of CES, there are many other potential causes. They include:

  • Trauma to the lower back, such as from a car accident or gunshot wound
  • Lumbar spinal stenosis (narrowing of the spinal column)
  • Spinal tumor or lesion
  • Spinal infections, such as meningitis
  • Inflammation of the spine
  • Spinal hemorrhage
  • Arteriovenous malformations (AVMs)

If you have symptoms of cauda equina syndrome, seek immediate help even if you do not know yourself to have one of the conditions above.

How is Cauda Equina Syndrome Diagnosed?

Many of the symptoms of cauda equina syndrome are also associated with less severe conditions, but if you experience multiple symptoms, symptoms that alarm you, or a rapid onset of symptoms, contact your medical provider and seek medical help immediately. Your initial provider may arrange to have you evaluated by a neurosurgeon or an orthopedic surgeon. If you cannot get an immediate appointment with your provider, consider going to the emergency room.

The bottom line is that it’s better to be safe than sorry. If you are concerned that you could have cauda equina syndrome, you should urge your treating physician to perform tests that could diagnose it or another condition. You may be asked to perform certain movements, such as standing, sitting, bending forward, backward, or to the sides, walking on your heels or toes, or lying on your back and lifting your legs.

You may also be subjected to a CT scan, MRI, or a myelogram, a test in which you are injected with dye so that a radiologist can better visualize your spine. You should receive a diagnosis of cauda equina syndrome if you have problems with your bladder, bowels, or sexual function and paresthesia in the “saddle” region.

What’s Next After a Diagnosis of Cauda Equina Syndrome?

Cauda equina syndrome is a surgical emergency. If you are diagnosed, you should have emergency surgery to relieve the compression of your nerves. This type of surgery is called a lumbar laminectomy. You may also be given medications to help you regain bowel and bladder control. Physical and occupational therapy may help you to regain strength and function over time.

But remember: the most important predictor of a good recovery is how quickly you are diagnosed and treated. If you have cauda equina syndrome and believe that your medical care providers failed to diagnose you in a timely fashion, consider speaking with experienced medical malpractice attorneys to determine if you may have a claim. Although CES is relatively rare, occurring in only one out of 65,000 people, the attorneys of Huegli Fraser have successfully resolved multiple CES malpractice claims. We invite you to contact us to schedule a consultation.