Cauda Equina  Syndrome:

Cauda Equina: set of intradural nerves that provide sensory/motor innervation from L2-S5

Nerve Roots of Cauda Equina:

• Hip muscles
• Lower extremity muscles
• Urinary and anal sphincters
• Sexual organ muscles

Causes of Cauda Equina:

• Disc herniation (MOST COMMON)
• Lumbar stenosis (OA)
• Trauma
• Infection/abscess
• Metastatsis/neoplasma (Metastasis most common, ependymoma or schwannoma possible)
• Inflammatory disease (CIPD, Paget’s, ankylosing spondylitis)

Symptoms – based on level 
Low back/radiating LE pain with at least one below

• Urinary incontinence/retention
• Fecal incontinence/retention
• Loss of anal sphincter tone
• Sexual dysfunction
• Saddle anesthesia/hypoesthesia

Treatment:
– urgent neurosurgical evaluation to reduce side/eliminate mass
– eradicate causative organisms

Most common organisms:
– staph (63%)
– strep (9%)
– gram negative anaerobes (16%)

Empiric antibiotic regimen: vancomycin and cephalosporin +/- nafcillin

Steroids indications:
– within 8 hours of traumatic spinal cord injury
– metastatic disease (followed by surgery/radiation)