KOCHI: “Doctor we have a situation,” I received a call from the emergency room. A lady in her late 20s was brought to me with conditions like severe back pain, weakness of both legs and was unable to pass urine and suffering from constipation for about 10 days...
Despite undergoing treatment in another hospital for two weeks, she was unable to recover. After a thorough diagnosis, it was found that the cluster of symptoms, including acute severe back pain with weakness and numbness of legs, urinary retention and constipation was nothing but the sign of acute cauda equina syndrome, a serious condition which affects the spinal nerves.
Cauda equina in Latin means ‘ponytail’ or tail of a horse. The collection of nerve roots, shaped like a horse’s tail, at the end of the spinal cord, is the reason why medical science named it Cauda equina.
This collection of nerves which originates at the end of the spinal cord at the lumbar spinal region goes down to both the legs, urinary bladder, urinary sphincter, sexual organs, anal canal and anal sphincter muscles. These nerves send and receive signals all across the body.
So when an injury such as herniated or prolapsed intervertebral disc, infection, fractures, tumour and such problems compress these nerves, leading to pain, weakness and incontinence.
Another classic feature of this condition is known as “saddle anaesthesia” or “saddle numbness”-which means the patient would complain of significant numbness or altered sensation in the undergarment area - buttocks, in between the legs and sexual organs. In men, loss of erection or erectile dysfunction occurs.
However, the condition and the cause of compression can be diagnosed with clinical examination and MRI scan.
Why time is important in Spine Disorders?
The syndrome demands immediate treatment, as the nerves could be permanently damaged, resulting in muscle paralysis of the legs, bladder and bowel.
However, if the compression is so severe in nature, even an early surgery would take time for recovery. There have been cases of people postponing timely treatment, this would only cause complications like irreversible spinal nerve damage.
The patient mentioned earlier underwent emergency spine surgery, and it took almost 1 year to complete recovery. Now, 7 years down the line, she is absolutely normal.
Red flag signs of cauda equina syndrome
Sudden severe back pain, bilateral leg pain(Sciatica), weakness of one or both legs.
Saddle numbness and urinary bladder issues such as inability to control urine, no sensation while passing urine, involuntary urination, loss of feeling the fullness of the bladder
Bowel dysfunction and loss of feeling of bowel movements
The author is the head of the Department of spine surgery at Medical Trust Hospital, Ernakulam. He is also the recipient of the Robert Winter Fellowship from the Scoliosis Research Society (USA)