Cauda Equina Syndrome (CES) is a condition in which motor, sensory and bladder functions are interrupted due to pressure on the nerves in the area where the nerve roots are dense, starting from the L5-S1 level where the spine meets the hip bone, called the "Cauda Equina".
Low back pain affects millions of people every year, and most cases heal without surgery. Very severe back pain is the first symptom of a disease that is little known and can be misdiagnosed. The patient in this picture usually comes to the hospital urgently. CES can cause incontinence (inability to hold urine and stool) and permanent paralysis.
CES; It is not related to age; it usually occurs in adults; what happens after trauma can happen at any age. It covers a very small percentage of patients who undergo surgery due to lumbar disc herniation.
What are the Causes of Kauna Equina Syndrome?
CES usually occurs as a result of large lumbar herniations. They occur when the disc comes out after reverse stretching or trauma and closes the canal. Sometimes it may occur when the old disc gradually comes out and compresses the cauda.
Other causes of CES can be listed as follows:
· Spinal lesion or tumors
Other causes of CES can be listed as follows: p> · Spinal infection or inflammation · Lumbar spinal stenosis · Trauma to the waist (gun injury, fall or traffic accident)Congenital anomalies · Spinal AVM · Spinal hemorrhages (subarachnoid, subdural, epidural) · Postoperative lumbar spinal surgery complication · Spinal anesthesia Symptoms and Diagnosis of Cauda Equina Syndrome CES symptoms also mimic other diseases. Symptoms and findings vary depending on the degree of pressure. Complaints: · Severe lower back pain · Motor weakness, loss of sensation and While the pain usually occurs in both legs, it may also be unilateral · Saddle-shaped numbness in the inner thighs and genital area · &nbs p; New-onset bladder dysfunction (may occur in the form of urine accumulation or incontinence) · Sensory abnormalities in the bladder and rectum · New-onset sexual dysfunction · Loss of reflexes in the lower extremities · Possible medical history of diseases · Recent lumbar trauma · Recent lumbar surgery · Cancer history · Recent history of severe infection Diagnosis Magnetic Resonance Imaging (MRI) Computed Lumbar Tomography Treatment The purpose of treatment is to ensure the return of lost functions. If left untreated, permanent paralysis may occur. Once the diagnosis is made, a neurosurgeon should be consulted, and the patient must be operated on 48 hours before the complaints and symptoms begin. In cases that exceed 48 hours, the chance of returning lost functions is less. The patient's functions may improve in the years after surgery, but we cannot see improvement in the early postoperative period. After surgery, medication and occasional urinary catheterization are among the things that should be done while waiting for recovery If CES has become chronic, it affects the patient both physiologically and psychologically. Patients with CES do not want to go out in public due to their inability to walk or urinary and fecal incontinence. Urinary incontinence is the most important social problem in these patients. CES patients frequently experience urinary infections. Sexual dysfunctions that occur may cause problems for both the patient and his/her partner. In case of severe neurogenic pain, the patient is started on medications and these may cause side effects. Neurogenic network usually occurs at night and may cause sleep problems in the patient, drowsiness may be troublesome, accompanied by motor loss and may make walking difficult. These patients should receive psychological support from their environment and family. They should meet with their doctor frequently for medication adjustments. In some patients, physical therapy may be used to cope with CES.
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