Cauda equina syndrome is an orthopedic emergency. It must be managed timely to prevent Complete bowel and bladder dysfunction. The symptoms are severe backache radiating to legs , bowel and bladder dysfunction and impotence including Saddle anesthesia. Immediate decompreSsion is required for treatment

1. CAUDAEQUINASYNDROME
PRESENTED BY,
RAKESH YADAV (40)
RITA K.C. (41)
ROHIT KUMAR JHA (42)

2. • CONTENTS
Anatomy
Introduction
Epidemiology
Etiology
ClinicalFeatures
Diagnosis
Treatment

3. Anatomy of Cauda Equina
• Latin- Horse tail
• Collection of L1-S5 peripheral nerves within
lumbar canal surrounded by dural sac
• Spinal cord ends at L1-L2 level

4. 4
CAUDAEQUINASYNDROME
Lower motor neuron lesion
Clinical diagnosis resulting from dysfunction of one / more of sacral root S2 and
below. One or more of following symptoms must be present,
a. Bladder and/ bowel dysfunction
b. Reduced sensation in saddle area
c. Sexual dysfunction
https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://pmc.ncbi.nlm.nih.gov/articles/PMC8782783/
&ved=2ahUKEwj3me6pjJePAxW5ia8BHewaH2AQFnoECBkQAQ&sqi=2&usg=AOvVaw3CKis9P6qqKbzH1tbYzPMb

5. 5
EPIDEMIOLOGY
An annual incidence of approximately 1.5 to 3.4 per million people (i.e., about
0.15–0.34 per 100,000 per year)
Prevalence 1 in 30,000 to 100,000 people per year
CES occurs in around 3% of all disc herniations
https://www.ncbi.nlm.nih.gov/sites/books/NBK537200/?utm_source=chatgpt.com

6. Central disc herniation Disc Prolapse Spinal stenosis
Infection Trauma
Iatrogenic
Etiology

7. Bowel and bladder dysfunction

9. Types
Name Abbreviati
on
Definition
Suspected CES CESS No bladder/bowel/genital/perineal symptoms, but bilateral sciatica or
motor/sensory loss in legs. (this is clinical CESS)
Or known large disc herniation on existing MRI (this is radiological CESS)
Symptom-only CES (early
CES)
CESE Normal bladder, bowel and sexual function but some sensory loss in perineum
or change in micturition frequency
Incomplete CES CESI Alteration in bladder/urethral sensation or function, but maintenance of
executive bladder control+/−perineal sensory changes, or sexual or bowel
sensory or functional changes
CES with retention CESR As in 3 but with painless bladder retention and overflow
Complete CES CESC Insensate bladder with overflow incontinence, no perineal perianal or sexual
sensation, no anal tone

10. Investigations
 MRI (study of choice)
 CT Myelography
 Urinary studies (PVR volume)
 Blood- ESR, CRP
 DRE (to check anal tone and perianal
sensation)

11. Management
• Neurosurgical emergency
• Immediate measures
• Early surgical decompression with removal of fragments compressing nerve roots
• Medical management (based on cause)
• Bowel and bladder care

12. Prognosis
 After surgery, Improvement in pain and weakness
 Return of bowel and bladder function in,
 88.9% if treated within 24 hrs
 79% if treated within 24-48 hrs and
 44% if >48 hrs.

14. THANK YOU