Syndroma caudae equinae

Cauda equina syndrome is more common than epicondylar or spinal condyle syndrome. It is caused by a lesion of the nerve roots of the distal spinal cord, arranged in the dural sac in the shape of a cauda equina (i.e. a horse's tail). It is therefore not a spinal cord lesion, but a root (peripheral) lesion, below the level of the L2 vertebra and below.

Etiology
The most common cause is a massive medial prolapse of the disc (L4/5). Other causes may be intraspinal expansion in this area.

Clinical picture
Cauda equina syndrome differs from epicondylar and spinal conus syndromes in that it is asymmetrical and sudden. The variability of the findings is due to the fact that there are many spinal roots in these areas that may be oppressed:


 * the main symptoms tend to be sharp, lancinating pains, the distribution of which corresponds to the lumbar or sacral roots affected in the cauda,
 * the sensation is also affected in the dermatome in question, and the sense for all qualities (global),
 * motor disturbances are also always present - the muscle groups innervated by the fibres of the affected roots are affected - accompanied by extinction of the corresponding tendon and periosteal reflexes,
 * later, if S3-S5 roots are also affected, urinary and faecal disturbances in the sense of incontinence may develop, but may not always be present,
 * trophic disorders are rare.

In addition, the following may be present:


 * lumbalgia
 * limb root iritis
 * progressive paraparesis
 * sensory disorders not only of the root distribution

Therapy
Cauda Equina Syndrome is an absolute and acute indication for surgery! (there is a risk of permanent sphincter disorder and impotence).

Early diagnosis (MRI, CT, PMG) and urgent surgery are essential.

Related articles

 * Epicon syndrome
 * Cone syndrome
 * Traumatic spinal cord syndromes