CAUDA EQUINA DAMAGE

The cauda equina is a leash of nerve roots extending from the end of the spinal cord (at the lower level of L1) to the intervertebral foramina (where they leave the spinal canal).

Compression of the cauda equina causes lower motor neuron lesions in the lumbar and sacral nerves supplying the lower limbs, bladder and rectum. Interruption of the bladder emptying reflex (S2, 3, 4) causes retention of urine.

The clinical features include:

•  Sciatic pain (often bilateral)

•  Peri-anal numbness (“saddle anesthesia”)

•  Urinary hesitancy or retention

•  Weak, flaccid legs

(“Saddle anesthesia” means loss of cutaneous sensation in perineum, buttocks, back of thigh, leg and sole of the foot.)

Often the clinical situation is not clear-cut and the cauda equina damage remains suspected rather than proved (a myelogram often appears normal).

Radiotherapy and/or high dose steroids can help, but the results are often disappointing in relieving pressure and reducing nerve damage.

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