The collection of nerves at the end of the spinal cord is known as the cauda equina, due to its resemblance to a horse’s tail as they extend from the spinal cord, through the lumbar spine and over the sacrum, and down the back of each leg. The cauda equina consists of about 10 pairs of nerve roots, some of which combine to form larger nerves in the lower body such as the sciatic nerve. The cauda equina is responsible for sensory and motor innervation to the pelvis and lower limbs, as well as bowel and bladder function.
Cauda Equina Syndrome occurs when a spinal disc presses on the nerve roots. If it is not diagnosed initially or properly and not take immediate treatment plan, it can cause permanent paralysis of the lower limbs, bowel and bladder incontinence, loss of sexual sensation and many other damages of the body.
Causes of Cauda Equina Syndrome:
CES occurs more often in adults than in children. A herniated disk is one of the most common causes of CES. Other possible causes of CES include:
- Spinal lesions and tumors
- Spinal infections or inflammation
- Lumbar spinal stenosis
- Violent injuries to the lower back (gunshots, falls, auto accidents)
- Birth abnormalities
- Spinal arteriovenous malformations (AVMs)
- Spinal hemorrhages (subarachnoid, subdural, epidural)
- Postoperative lumbar spine surgery complications
- Spinal anesthesia
Symptoms:
- Urinary retention
- Urinary and/or fecal incontinence
- Sharp or stabbing pain in the legs or lower extremities
- Localized lower back pain
- Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet
- Sexual dysfunction
- Achilles (ankle) reflex absent on both sides
- Absent anal reflex and bulbocavernosus reflex
- Gait disturbance
Testing and Diagnosis
- Patient medical history and physical exam
- CT Scan
- X-ray
- Magnetic resonance imaging (MRI)
Management:
In severe condition surgery must be done quickly to avoid any permanent damage. But before and after the surgery or in acute case patient have to take physiotherapy treatment to reduce his pain, regain his weak muscle’s strength, improve muscle power, ROM, balancing, standing, walking, restoring bowel bladder function, avoid bedsore etc.
Physiotherapy:
Manual therapy-
- MFR (Myofascial Release)
- Stretching exercise of spastic muscles (Hams, Quads etc.)
- Strengthening exercise for weak muscles ( Gluts, core muscle)
- Isometric exercise
- Pelvic floor muscle exercise
- Kegel exercise
Electrotherapy-
- HIL (High Intensive laser) : Reduce pain & helps to heal
- UST (Ultra Sound Therapy) : Reduce pain, inflammation and swelling
- ES(Electrical Stimulation) : we can use 4pole IFT , TENS & Russian stimulation to reduce pain & strengthening purpose
- IRR for warming
Rehabilitation:
Rehabilitation of CES depends on the severity of the injury. If permanent damage occurs, then Bladder-Bowl impairment control may result. Once surgery is performed, resting is required until the bladder-bowel dysfunction can be assessed. Urinary catheterization may help with bladder control. Gravity and exercise can help control bowel movement.
Rehabilitation Procedure Will Be Started Mostly Sit To Stand , Gait Training , Walker Walking Then Balancing Exercise, Stair Climbing And Related Exercise According To The Condition And Involvement Of Neuron Lesion Treatment Will Be Variable.