At the bottom of the spine is a bundle of nerves called the ‘cauda equina’, so called because it has been likened to a horse’s tail. Together these root nerves serve the lower limbs, provide sensation to the buttocks and genitalia, and control the bowel, bladder and sexual function.
If these nerves should become compressed for any reason – for example, because of a slipped disc – they will begin to suffer injury and lose function. A complex of symptoms and signs will then develop which make up a condition known as Cauda Equina Syndrome. These consist of low back pain, unilateral or bilateral sciatica (with or without motor and/or sensory loss in the lower extremities), sensory disturbance in the saddle area and impairment of the sphincter function. Implicit in the diagnosis of this condition is impairment of bladder control.
What is acute Cauda Equina Syndrome?
However, the speed at which Cauda Equina Syndrome progresses is very variable. At one end of the spectrum it may remain in the early stages (known as incomplete) and slowly progressive over a number of days. In other cases there may be an acute prolapse of a large disc fragment which isolates the spinal canal, resulting in complete Cauda Equina Syndrome within a matter of hours. This is characterised by painless urinary retention until the bladder will hold no more urine, after which dribbling overflow incontinence.
When a patient’s condition deteriorates very rapidly and progresses to the complete stage within hours, he or she is said to have acute Cauda Equina Syndrome.
Treating acute Cauda Equina Syndrome
Any patient with Cauda Equina Syndrome must undergo urgent treatment. This is because if the nerves are compressed, the blood supply will be cut off. The lack of blood and oxygen will quickly cause the cells in the nerves to die, after which there will be no recovery of function. This means a patient will be left with permanent neurological complications.
If a patient’s condition progresses very slowly, there will be more time in which to relieve compression before nerve cells begin to die. But if a patient’s condition is acute, there will be a very small window of opportunity in which to make an accurate diagnosis and perform emergency decompression surgery before the syndrome becomes irreversible.
Due to the urgency of treatment, medical professionals must act immediately if a patient is displaying symptoms similar to Cauda Equina Syndrome. An urgent MRI scan must be performed and, if a cauda equina lesion is present, emergency surgery carried out. Only with such speed will a patient stand any chance of making a full (or at least acceptable) recovery. If doctors fail to do so, there could be a case of medical negligence.