Cauda Equina Syndrome; a Medical Emergency

It is a medical emergency, that entails compression of lumbar and sacral nerve fibers.

RISK FACTORS
– Cancers
– IV drug use
– Immunocompromised state
– Trauma

CLINICAL PRESENTATION
– Low back pain
– Sciatica / radicular pain
– Lower extremity weakness or numbness
– Bladder / Rectal dysfunction
– On exam – lumbosacral weakness, decreased dorsiflexion, quad strength, decreased deep tendon reflexes, saddles anesthesia, decreased anal sphincter tone

DIAGNOSIS
– MRI is the definitive imaging study
– CT myelogram maybe done if MRI not available
– CBC, UA, ESR and CRP

MANAGEMENT
– Stat Neurosurgery consult
– Analgesics
– Methylprednisolone for acute spinal cord trauma (<8hrs) – 30mg/kg IV bolus, then 5.4mg/kg/h infusion for 24hrs

References:
1. Cauda Equina Syndrome. 5 minute consult. (Accessed 27 Feb 2019)