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Cauda Equina syndrome

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Spine lecture spinal cauda equina syndrome

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Cauda Equina syndrome

  1. 1. Cauda Equina Syndrome • Upper Chesapeake medical Center Spine Conference • Friday June 2nd, 2017
  2. 2. 39 year old woman Cc: B sciatica perineal anesthesia HPI: 2 weeks of symptoms, she thought it was MS PMH: bipolar, gastic sleeve 120/40 2014, SH: disability, lives alone
  3. 3. L3L4 L4L5
  4. 4. L5S1
  5. 5. Note the R S1 nerve root
  6. 6. Typical L5S1 disc herniation
  7. 7. cauda equina
  8. 8. Cauda Equina Syndrome
  9. 9. Pain saddle anesthesia sacral nerve root dysfunction
  10. 10. Bladder/Urination symptoms Lack of bladder fullness sensation Urinary retention Urination down thigh in women Overflow incontinence
  11. 11. Spine 2000 meta-analysis 322 patients chronic LBP worse B/B bowel dysfunction worse urinary older age worse sex function <24 hours no better than 24-48 hours all patients have same outcome >48 hours significant difference in B/B function and sensation for patients <48 hours and >48 hours
  12. 12. • B S1-S5 100% (bowel/bladder loss) • B S2S5 100% • B S3S5 60%/75% • B S4S5 0%/40% • Unilateral S3 33%/40%
  13. 13. Nicholas Vyner Todd, UK neurosurgeon, Newcastly upon Tyne, UK Categories: 1. Suspicious 2. Incomplete 3. Retention (urinary) 4. Complete Br J Neurosurgery 2016 review article 158 papers <24 hours surgery 89% normal bladder <48 hours surgery 79% normal bladder >48 hours surgery 44% normal bladder Emergency MRI critical for suspicious patients B sciatica is suspicious Incomplete bladder dysfunction patients are true emergencies “out of hours” surgery carry increased morbidity and mortality
  14. 14. Shanghai, china
  15. 15. Early: B symptoms lower extremity m/s incomplete retention
  16. 16. BLE pain BLE paresthesia B motor LE B sciatica Perineal paresethsia Perineal pain Reduction bladder Reduction bowel Bladder dysfuction Bowel dysfunction 222 cases
  17. 17. Thanks

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