Introduction
Cauda Equina Syndrome is seen in injuries below the level of first lumbar vertebra. It is essentially an injury to the nerve roots below L1. Compression of these nerves can lead to permanent damage if not promptly treated, making CES a true aesculapian emergency.
Etiology
Cauda Equina Syndrome most commonly arises from a massive herniated disc in the lumbar spine, particularly at the L4/L5 or L5/S1 levels. Other causes include:
- Tumors of the spine
- Pott’s disease
- Protrusion of disk—large midline disk prolapse at 4–5
- Fracture dislocation of the thoracolumbar spine.
- Spinal stenosis (narrowing of the spinal canal)
Signs & Symptoms :
The patient complains of back pain, difficulty in micturition, perineal pain, impotence in male, etc.
- Sensory signs: The most salient feature of a cauda equina lesion is an area of saddle-shaped hyperesthesia and later anesthesia (involving, anus, buttocks and perineum) .
- Motor signs: Flaccid paralysis below the knee.
- Reflexes: Ankle jerk is lost and the knee jerk is increased due to the weakness of the opposing hamstrings.
- Bladder symptoms: Common problems are retention of urine with overflow. Even after a severe cauda equina, lesion reflex micturition is established later, reflex being mediated through the vesical plexus.
- Anal sphincter relaxation: leading to incontinence of the bowels.
Investigations:
Plain X-ray, CT scan, MRI of the affected part is approved.
Physiotherapy Management:
While surgical decompression is the primary treatment for CES, physiotherapy plays a critical role in post-operative recovery:
- Pain management: Utilizing modalities like TENS, cold therapy or heat therapy.
- Mobility restoration: Gentle range-of-motion exercises for the spine and lower limbs .
- Bladder and bowel retraining: Working in conjunction with other specialists to improve control and function.
- Sensory re-education: Manipulation to help regain sensation in affected areas.
- Strengthening: Gradual strengthening of glutes, core muscles and leg muscles to improve endurance and function.
- Gait training: Re-education of walking patterns to improve coordination and balance.
- Patient education: Guidance on activity modification, posture, and self-management strategies.
Conclusion:
Cauda Equina Syndrome demands immediate medical attention due to its potential for irrevocable neurological deficits. Early diagnosis and surgical intervention are paramount, followed by a comprehensive physiotherapy program to enhance. recovery, restore function, and improve the patient’s quality of life.