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.

Laminectomy

Laminectomy is a surgical procedure to remove a portion of the vertebral bone. This is done to relive the pressure on the nerve roots. The lamina is the vertebral bone that is operated upon so as to reduce pressure on the spinal cord and nerve roots. Spinal stenosis usually affects older persons due to degeneration and subsequent enlargement of the facet joints. This leads to acute pain. Laminectomy is also performed to treat conditions such as herniated disks and spondylolisthesis. A patient may need to spend a few days in the hospital and will require physio therapy for embarking on activities such as sitting, standing and walking. In some cases there can be complications such as nerve damage, spinal fluid leak, worsening back pain and bleeding.

MRI scan

During a MRI scan, pictures of almost all the tissue in the body are taken. The tissue that has the least hydrogen atoms, such as the bones turns out dark. The tissues that have many hydrogen atoms, such as fatty tissue looks much brighter. The timing of the radio wave pulses is constantly changed to gain information about the different types of tissues present. An MRI scan is normally used as an extremely accurate method of disease detection and structural abnormalities throughout the body.

Patient with any metallic materials within the body must notify their physician prior to the MRI scan. This is because, metallic chips, materials, metal implants, surgical clips or foreign materials (artificial joints, metallic bone plates or prosthetic devices, etc) can significantly distort the images obtained by an MRI scanner. Patients with pacemakers, metal chips or clips in and around the eyeballs cannot be scanned by an MRI because of the risk that the magnet may move the metal in these areas. Patients with artificial heart valves, metallic ear implants, bullet fragments and chemotherapy or insulin pumps should not undergo MRI scanning.

MRI scan can cause a small risk to the fetus in the first 12 weeks of pregnancy. Therefore scans are not performed on pregnant women. The MRI machine produces loud thumping and humming noise when the procedure is performed. Therefore ear plugs are usually given to the patients to reduce the noise. MRI scans are a useful aid in the assessment of certain back conditions. MRI is an aid to detail studies of nerve root injuries like lumbar disc herniation and lumbar spinal stenosis. It is also extensively used in spinal disc and lumbar disc diseases and isthmic spondylolisthesis. It is also useful to rule out tumors and spinal infections.