Cauda equina syndrome and its treatment. The nerve bundle at the end of our spinal cord is called the cauda equina. And let’s say it a little more simply. The spinal nerve passes through the canal or tubular part of the spine. The spinal cord descends from the neck down into this canal. This spinal cord is divided in various directions in the ‘lumbar region’ or the waist. The word cauda equina means horse’s tail. In fact, because of the division of the nerves from the spinal cord in this way, the nerve bundle looks like a horse’s tail. This is why it is named like this. Nerve endings from the spinal cord send and receive signals to different parts of the body. For example, nerve bundles control movement of the legs or retention of urine in the bladder.
Cauda equina syndrome (CES) occurs when multiple nerve roots of the ‘cauda equina’ are damaged in the lumbar and sacral regions of the spine.
The question is why is this a problem? What are the symptoms?
The most common cause of CES is the displacement of the ‘disc’ between the two vertebrae of the spine. In medical terms this problem is called ‘disc prolapse’. Apart from this, there is also a risk of spinal cord fracture due to trauma and tumor problems.
When do you understand ’emergency’?
Just as it is important for an orthopedic physician or neurosurgeon to understand that a patient has CES, it is equally important for a general physician to suspect the disease based on the symptoms. The same applies to emergency department personnel and other specialists in medical centers. Because the symptoms of CES are often delayed. Because this disease has various physical symptoms that indicate other diseases as well. For example, some patients lose bladder control. No one has any control over bowel movements. Weakness during physical intercourse or numbness in the back are also symptoms of CES.
Known symptoms of the disease
• Urinary retention problem: Patient’s bladder fills up with urine. But the patient does not feel any separate urge to urinate.
• Urinary, Faecal Incontinence: Urinary incontinence can occur due to excessive accumulation of urine in the bladder. That is, the problem of urine leakage occurs without the knowledge of the patient. On the other hand, with loss of control over the anal sphincter, the patient is also at risk of passing school without realizing it.
• Sensory problems such as ‘saddle anaesthesia’ may occur. In this case, the anus, genitals and back can become numb.
• Loss of control over normal functions of the lower body but indicates multiple nerve damage.
• Leg and back pain. This pain is also called sciatica pain.
• Problems arise in intimate physical relationships. If a person develops any of the above physical symptoms, seek medical advice immediately. Because it is necessary to understand whether the problems are caused by CES or not.
Diagnostic tests to understand CES
A neurological examination of the feet must be performed if CES is suspected. At the same time sensitivity in the area around the anus should also be checked. In case of CES, the area around the anus is usually numb.
In this case, the condition of the intravertebral disc, ligamentum flavum, dural sac and nerve root can be understood by doing MRI examination.
What is the treatment?
Surgery is the only cure for CES. As mentioned earlier, problems with CES can be caused by the displacement of discs between the vertebrae of the spine. In this case, it is necessary to remove the pressure from the nerve root.
So the ‘disc’ is returned to its normal position through a special type of operation or discectomy. The pressure on the nerve bundle is relieved. However, during the operation, the surgeon has to perform the surgery very carefully. Because there is a danger of harming the patient in the slightest carelessness. According to articles published in various medical journals, surgery performed less than 48 hours after the onset of symptoms has better results than surgery performed more than 48 hours after showering. However, if the operation is performed even after a long period of time, the physical problems are definitely relieved to a large extent.
Rehabilitation is essential
Some patients require several days of follow-up after surgery. The help of rehabilitation medicine may also be needed. Because it has been seen that even if control over the bladder is lost, sometimes it takes a long time for the lower body organs to return to full function. Patients may require self-administered catheters with medication after surgery. In this case, the patient regains control over the bladder and bowels, albeit slowly.
Remember
CES can affect the patient both physically and mentally. Patients’ quality of life is severely disrupted, especially with chronic CES. Due to excruciating pain or inability to pass stool and urine, the patient cannot perform daily activities properly. Can’t socialize. Patients with CES remain at risk of recurrent urinary tract infections. Weakness also occurs during intimate intercourse, which is a very distressing experience for the patient as well as his partner. In such a case, complications arise such as the person’s relationship breaks up or he goes into depression.
In some cases, the patient also needs to take painkillers to reduce the pain. Such drugs also have various side effects. In some cases, however, patients benefit greatly from physical therapy and psychological counseling.
Last word
CES is not the end of life. Rather, this disease can be cured with proper treatment. So, if symptoms appear, definitely discuss with the doctor. stay healthy
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