The Dangers of Delayed Cauda Equina Syndrome Diagnosis

Cauda equina syndrome (CES) is a severe type of spinal stenosis where all the nerves in the lower back suddenly become compressed. A herniated disc is one of the most common causes of CES.

In most cases, the bladder and the legs are the first areas to be affected by CES. Other symptoms include sciatica, weakness or numbness in both legs that is severe or getting worse, numbness around or under the genitals, or around the anus. The onset of symptoms can develop suddenly or gradually over weeks or months.

A doctor can diagnose cauda equina syndrome. In order to confirm a diagnosis, the following may need to be established:

• A medical history, in which you answer questions about your health, symptoms, and activity
• A physical exam to assess your strength, reflexes, sensation, stability, alignment, and motion. You may also need blood tests
• Magnetic resonance imaging (MRI) scan, which uses magnetic fields and computers to produce three-dimensional images of your spine
• A myelogram – an X-ray of the spinal canal after injection of contrast material – which can pinpoint pressure on the spinal cord or nerves
• A computed tomography (CT) scan

Cauda equina syndrome requires prompt treatment to relieve pressure on nerves, it is best treated with decompression by a lumbar laminectomy. Surgery must be done quickly to prevent permanent damage, such as paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems. Whilst there is conflicting evidence in literature as to the timing in treatment, evidence suggests that to provide maximum potential surgery should occur within 24-48 hours of the onset of symptoms.

Unfortunately, even with treatment full function may not be achieved and the level of improvement will depend on how much damage has occurred. If surgery is successful, the patient may continue to recover bladder and bowel function over a period of years.

Clinical diagnosis is difficult as back pain is a common presentation however in order to have a favourable outcome and avoiding permanent neurological damage it is vital that any red flags of CES are managed promptly and appropriate imaging carried out such as MRI/CT scan as this can assist in early diagnosis and thus early treatment.