Definition: Syndrome characterized by dysfunction of multiple lumbar and sacral nerve roots in the lumbar vertebral canal due to compression

Anatomy

Compression from various causes results in lower motor neuron pathology

The spinal cord terminates in the conus medullaris at the T12/L1 vertebral body in adults

Saddle anesthesia: Reduced or absent sensation in the perineal area (S2-S4 innervation)

Hypotonia/atrophy of the lower extremities (in chronic presentations)

Decreased sensation in the perianal area – up to 93% ( Korse 2017

Disruption of autonomic innervation leads to retention and overflow incontinence

Change in sensation in the lower extremities

Seen in up to 97% of patients ( Korse 2017

Symptoms may develop acutely or progressively over time

The presence of urinary retention/incontinence at presentation is a predictor of poor outcomes

Surgery should be performed within 24 hours to increase the chance of better outcomes ( Todd 2005

Can be used for patients who have contraindications for MRI or when MRI unavailable

Requires spinal tap followed by injection of contrast. This limits it’s utility

Allows for visualization of the spinal cord and associated abnormalities

Plain X-rays and CT scans can show bone and soft tissue abnormalities but not spinal cord abnormalities

Normal post-void residual (PVR) < 50 ml (may be up to 100 ml in patients > 65 years)

Cauda equina syndrome is a rare emergency with devastating consequences

Early recognition is paramount as the presence of bladder dysfunction portends bad functional outcomes

The presence of bilateral lower extremity weakness or sensory changes should alert clinicians to the diagnosis. Saddle anesthesia (or change in sensation) and any bladder/bowel changes in function should also raise suspicion for the disorder

MRI is the diagnostic modality of choice though CT myelogram can be performed if necessary