Cauda Equina Syndrome (CES)

Lower back pain is one of the most common ailments we treat at Kelsey-Seybold Spine Center. More often than not, the pain is easy to diagnose, and the source is obvious. But severe back pain can also be a symptom of a lesser known condition that’s often misdiagnosed called Cauda Equina Syndrome (CES).

There are a cluster of nerve roots at the end of the spinal cord called cauda equina because they resemble a horse’s tail. When these nerve roots, which send and receive messages to and from the lower limbs and pelvis organs, are compressed, the motor and sensory function of the lower extremities and bladder are disrupted.

CES is considered an emergency and should be given immediate medical attention. If not addressed quickly, it can lead to incontinence or even paralysis.

Common Causes

The most common cause of CES is a severely herniated disc in the lumbar region of the spine. Other potential causes include:

• Spinal lesions and tumors
• Spinal infections or inflammation
• Lumbar spinal stenosis
• Violent injuries to the lower back
• Birth abnormalities
• Spinal arteriovenous malformations
• Spinal hemorrhages
• Lumbar spine surgery complications
• Spinal anesthesia

Signs and Symptoms

CES is often misdiagnosed because it mimics the symptoms of other conditions, such as a herniated disc (which CES can accompany), peripheral nerve disorder, and spinal cord compression. For this reason, it’s important to seek immediate medical attention if any of the following symptoms are present:

• Severe lower back pain
• Weakness, loss of feeling, or pain in one or both legs
• Loss of feeling in the “saddle” area, or the part of the body that would sit on a saddle
• Sudden onset of urinary retention or incontinence and/or bowel incontinence
• Loss of sensation in the bladder or rectum
• Sudden onset of sexual dysfunction
• A loss of reflexes in the extremities

Diagnosis and Treatment

Anyone experiencing symptoms of CES should consult a neurosurgeon or spine expert as soon as possible. When surgical intervention is performed within 48 hours after the onset of symptoms, there’s a far greater chance of retaining sensory, motor, urinary, and rectal function. Surgery can still be performed after 48 hours, but the chances of retaining function decrease the more time that passes. If left untreated, CES can result in permanent paralysis and incontinence.

CES is typically diagnosed via an MRI or a myelogram, which is an X-ray of the spinal canal using contrast to show displacement of the spinal cord or spinal nerves. Once diagnosis is made, immediate surgery is almost always recommended. Any function that was lost should continually improve over the years following surgery.

CES is a serious and often frightening condition that causes severe pain, but the experts at the Kelsey-Seybold Spine Center in Houston can quickly diagnose CES and recommend immediate treatment to reverse any lost function.