AM Report 9/22/2016 – Cauda Equina Syndrome

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)

Symptomsbased 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

new-cesa-dl-back-21-5-13

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)

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