Cauda Equina Syndrome

Lower back pain is normally not a panic situation. However in a few cases the pain could be due to cauda equina syndrome, which is a rare neurological condition and requires immediate medical attention rather surgical intervention.

Cauda equina is a Latin term which means horse's tail; the nerves at the end of the spine resemble the horse tail. Cauda equina is formed by the nerve roots caudal close to the termination point of the spine. Extreme compression or inflammation of the spinal nerve roots (nerves branching off the spinal cord). These nerves are located at the lumbar spine i.e. the lower end of the spinal cord. They help in transmitting messages to and from the legs, pelvic organs and feet. The syndrome is more common in adults but can occur in children too. If not treated immediately, it may lead to paralysis of the lower limbs, urinary incontinence, etc.

Cauda equina syndrome causes

• Spinal tumor or lesion
  
• Narrowing of the spinal canal or spinal stenosis
  
• Spinal infection, hemorrhage or fracture
  
• Ruptured disc in the lumbar region
  
• Herniated disc
  
• Inflammatory conditions
  
• Birth defect, this condition is more prevalent in adults however it can occur in children who are born with defects of the spine.
  
• Spondylolisthesis
  
• Accident/trauma

The condition is as such that it cannot be diagnosed very easily, common symptoms reported include severe lower back pain, sudden sexual dysfunction, pain, numbness or weakness in either one or both the legs or incontinence of bowel or bladder or retention of bowel or bladder movements. Diagnostic methods include:

• MRI
  
• Myelogram
  
• CT scan
  
• Urodynamic studies to monitor bladder function

Cauda Equina Syndrome Treatment

The condition cannot be prevented however it can be diagnosed at the early stages so as to prevent irreparable damages.

• Immediate treatment to ease pressure off the nerves.
  
• Surgery so as to prevent any further related complications caused by the condition.
  
• Treatment has to be given within 48 hours of onset of pain.
  
• Rehabilitation includes physical therapy and measure to handle bowel and bladder control.
  
• Anti-inflammatory medications.

Lumbar Herniation

Hernia is an abrupt condition which usually leads to an emergency that can be life threatening. Disc herniation is one of the most frequent conditions of the spine especially pertaining to sport injuries and trauma. The lumbar region begins from distal end of the vertebral column consisting of five vertebrae. They are chronologically represented as L1, L2, L3, L4 and L5 respectively. The vertebral column contains discs which enable them in dexterity and movement in absorbing the shock and friction during any kind of physical activity. About 60% of people experience because of the disposition of these vertebral discs located in the lumbar region.

Clinical manifestations

Herniated discs can cause excruciating pain because of the location and associations with numerous nerve endings and blood vessels passing through the region. The initiation of the lumbar hernia is predominantly because of wear and tear caused to the disc or sometimes due to trauma. The inter vertebral discs contain viscous nucleus which tends to permeate to the outer region of the disc causing pressure on it to slip forward or herniate. The first noticeable symptom of lumbar hernia is observed at this point. The patient complains of radiating pain in the sciatic or thigh region. Other symptoms include lower back pain, weakness in the legs and numbness or tingling sensation in the feet.

Lumbar herniation can also be connected with other underlying medical conditions such as cauda equina syndrome in which urinary incontinence is noticed. The spinal roots are usually impaired because of compression thus leading lack of bladder control.

Diagnosis of Lumbar herniation

Lumbar herniation requires radiological and neurological diagnostic methods to identify the exact location of the herniated disc and to identify the presence of any inflammation and nerve root compressions. Neurological examinations also include nerve conduction studies to identify the presence of neurogenic or myogenic conditions caused due to the herniated disc. It also helps in identifying neuromuscular deterioration and weakness associated with it. Physical examination maneuvers such as straight leg raise is done to diagnose the origin of pain radiation. MRI also provides a comprehensive analysis of the herniated disc along with its adjacent impaired neuromuscular involvement.

Treatment

Herniated discs are treated depending upon the intensity of the damage caused. Sometimes physiotherapy on a regular basis can reduce the pain caused because of movements at a certain angle. Anti-inflammatory drugs, epidural administration of steroids can reduce the pain to a greater extent. Other options includes surgical interventions such removal of the disc.