Cauda Equina Syndrome–A Back Injury to be Avoided!

I have handled many cases over the years involving injuries to the lower spine or back.  Fortunately, very few of my clients with lumbar back injuries have developed cauda equina syndrome.

What is the cauda equina?   This is a Latin term (“horse’s tail”) describing a collection of nerves coming off the lower end of the spine that go to the legs and pelvic region.  “Cauda Equina Syndrome” or “CES” is a rare condition describing a constellation of symptoms that can occur in the lower part of the body.  The symptoms occur in the groin and pelvic area, the external reproductive organs, bladder, the lower portion of the colon and rectal area, and the sensory nerve endings in the skin in this part of the body.  CES can also affect the legs.  Individuals with CES suffer from bladder and bowel dysfunction; males often have erectile dysfunction and females often have numbness in their own sexual organs.  Paralysis of the legs can occur.  Cauda equina syndrome patients often have to insert a urinary catheter to empty their bladder or get an implanted device called a “bladder stimulator.”   They sometimes must use the same techniques as paralyzed patients to instigate a bowel movement.

This condition can occur when certain injuries happen to the lower part of the spine.  A severely ruptured or herniated disk at spine level L5-S1–near the lowest end of the spine–can put pressure on the nerve roots that exit the spinal cord at that level.  Those nerves go out to and “enervate” the bladder, the anus and rectum, the sexual organs, and the legs.  If that ruptured disk pressure is strong enough, acute bladder and/or bowel incontinence or an inability to void (acute constipation and inabilty to empty the bladder) are likely to occur.  Pelvic numbness, and erectile dysfunction in men, will also occur.

That ruptured disk material needs to be removed from the nerve root within approximately eight (8)hours of the first of these acute symptoms in order to prevent permanent nerve damage. If that permanent nerve damage occurs, the resulting symptoms and deficits are called “cauda equina syndrome.”    These problems are not reversible, so these nerve damage deficits can become lifelong symptoms.

How do you prevent this debilitating condition?  Well, if you have any of those symptoms, especially bladder or bowel incontinence, then you need to immediately report the new symptom to your spine doctor.  Call the doctor immediately.  Do not wait until your appointment, even if it is the same day.  If your spine doctor has not given you instructions within a half hour or so, go to the emergency department at a hospital that is equipped to perform spine surgery.  (Find out ahead of time from your doctor where he performs spine surgery and go there!)   You may need emergency spine decompression surgery to prevent permanent damage.

I had have had two male clients in the past decade who developed these cauda equina syndrome symptoms after a serious back injury, and in both cases, they went to the emergency room only to be told “You’ll be ok.  You can go home.”   In both cases, the men were not “OK” and both needed emergency spine surgery.  Neither got it in time; both got decompressive spine surgery about a day too late after visiting other, more diligent, doctors.  Both ended up with permanent bladder, bowel and erectile dysfunction, and neither man was able to return to his previous occupation.  In both cases, the terrible outcomes could have been avoided if the doctor that evaluated the man initially at the Emergency Room had sent him immediately into back surgery.  If you go to the Emergency Room with any of these CES symptoms after a lower back injury, insist on being evaluated by a neurosurgeon or an orthopedic spine surgeon before you leave the hospital.  Being assertive on this point may save you a lifetime of using a urinary catheter and other unpleasantries.

Here is a link I recommend to learn more about CES:  http://www.webmd.com/back-pain/guide/cauda-equina-syndrome-overview