Cauda Equina Syndrome

Cauda equina syndrome is a serious condition in which a large collection of nerve roots within the lumbar spinal column is suddenly compressed. Sudden compression of these nerve roots may be due to a large lumbar disc herniation, infection, recent surgery, trauma, fracture, spinal hematoma or compressing tumor. Regardless of the cause, cauda equina syndrome is a neurosurgical emergency.

Symptoms of Cauda Equina Syndrome

Patients may experience urinary retention which leads to inability to completely empty the bladder. Patients may feel a sense of fullness in their bladder even after voiding. Patient’s may also experience overflow incontinence and present with urinary and/or fecal incontinence (inability to control bowel and/or bladder function). Patients may also present with “saddle anesthesia”; this is the most common sensory deficit with cauda equina syndrome. Saddle anesthesia involves numbness in the area of the anus, lower genitals, peritoneum, buttocks, and posterior-superior thighs. Once perianal “saddle” anesthesia develops, patients tend to have permanent bladder paralysis. Patients also present with significant motor weakness usually involving more than one nerve root innervating the lower extremities. If untreated this may progress to paraplegia (paralysis of the lower extremities). Patient also often present with low back pain and/or sciatica. Sciatica is usually bilateral but may be unilateral or entirely absent; prognosis may be worse when absent or bilateral.

Treatment for Cauda Equina Syndrome

WARNING: If a patient or healthcare provider suspects cauda equina syndrome, emergent neurosurgical evaluation is warranted.

Treatment for cauda equina syndrome focuses on decompressing the lumbar spinal nerve roots (cauda equina). This is accomplished surgically by performing a laminectomy and removing the offending compressing element(s). The lamina of the spinal column allows access to the thecal sac that contains the lumbar nerve roots referred to as cauda equina or horse’s tail. Once the thecal sac is exposed the offending herniated disc, spinal tumor, spinal hematoma or other is surgically removed in an effort to decompress the thecal sac and contained nerve roots. It is highly recommended that this procedure be performed within 24 hours of the onset of symptoms. Although timing of surgery is somewhat controversial, there is a general consensus that the onset of symptoms of cauda equina syndrome is a neurosurgical emergency and affected patients should proceed to the emergency room as soon as possible. The goal of surgery is to decompress the cauda equina lumbar nerve roots in time to prevent permanent neurologic deficit.

At Princeton Neurological Surgery, Dr. Lipani is a board certified fellowship trained spine surgeon in New Jersey who performs minimally invasive spine surgery as well as complex spinal procedures. Dr. Lipani is a specialist in the treatment for cauda equina syndrome and many other spinal conditions such as spinal stenosis, herniated discs, degenerative disc disease, low back pain, neck pain, spinal tumors, spinal cancer and more. Dr. Lipani treats patients from around the world, New York, Pennsylvania, and New Jersey including locally from Princeton, New Brunswick, Hopewell, Pennington and communities throughout Somerset, Middlesex, Ocean, Burlington, Monmouth and Mercer Counties for cauda equina syndrome. Dr. Lipani offers image guided spine surgery approaches for cauda equina syndrome treatment, tailored to the needs of each patient. For state-of-the-art cauda equina syndrome treatment, call or email us to schedule a consultation at our offices in Hamilton, New Jersey or Bridgewater, New Jersey!

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