Horse tail syndrome is associated with a number of lower body ailments, including sensory disturbances and significant pain. The cause of the disease can be both injuries and neoplastic processes in the structures of the spinal cord. What is the treatment of cauda equina syndrome?
Cauda Equina Syndromeis a symptom complex resulting from damage to the terminal thread and the lower roots of the spinal nerves. The spinal cord, which runs inside the spinal canal, ends at a level that corresponds to the first or second lumbar vertebrae. The structures of the nervous system, however, extend even further - below this area are the lower roots of the spinal nerves. Along with the so-called With the end thread, these roots are referred to as a horse's tail due to their resembling structure. Although the components of the cauda equina are protected by the structures of the spinal canal, they can still be damaged, a symptom of which is known as cauda equina syndrome. The diagnosis of cauda equina syndrome should be made as soon as possible, because when pharmacotherapy is possible in some patients and their condition can be carefully monitored, in others it is necessary to implement urgent surgical procedures.
Ponytail Syndrome - Causes
Cauda Equina Syndrome can be caused by virtually any disorder that results in narrowing of the spinal canal, thereby compressing nerve structures. The following units are among the most common causes of the disease:
- trauma to the lumbar and / or sacral parts of the spine (especially with accompanying fractures or hematoma formation in the spinal region),
- nucleus nucleus hernia,
- spinal cord tumors (e.g. meningiomas, astrocytomas),
- metastases to the spinal cord (lung, breast and kidney tumors most often metastasize to this part of the body),
- infections within the spinal cord (e.g. tuberculosis, syphilis),
- narrowing of the inside of the spinal canal due to birth defects.
Less common causes of the syndrome include spinal hemorrhages (both supra- and subdural), arteriovenous malformations, andsarcoidosis and multiple sclerosis.
Cauda Equina Syndrome can also be a complication after a patient has been subjected to certain medical procedures. For example, it is caused by the use of spinal anesthesia - in such a situation the diagnosis of iatrogenic cauda equina syndrome is made.
Cauda Equina Syndrome: Symptoms
The disease can appear relatively suddenly and develop insidiously, therefore the clinical picture of cauda equina syndrome is variable. The ailments related to the discussed unit are usually:
- pain in the lumbar region of the back, but also symptoms of sciatica type (pain radiating from the loins to the buttocks, through the back of the thigh and lower leg to the foot),
- sensory disturbances, which mainly affect the buttocks, perineum and the rear parts of the thigh, lower leg and the inner part of the foot; they may concern one half of the body, but also both,
- muscle weakness in the lower limbs (symmetrical or asymmetrical),
- sphincter dysfunction (mainly the urinary bladder sphincter, which is related to the tendency to retain too much urine in the bladder; in advanced cases, the function of the sphincter responsible for the control of defecation may also be impaired).
Although they occur much less frequently than those mentioned above, sexual dysfunction may also appear in patients with cauda equina syndrome. Patients may experience sensory disturbances in the genital area, especially in the clitoral or penis area. In men with this syndrome, erectile dysfunction may occur.
Horse tail syndrome: diagnosis
The diagnosis of the cauda equina syndrome can be suspected on the basis of a physical examination (i.e. medical history) combined with a physical examination. Among the abnormalities that may be encountered is the positive Laseque symptom (found when a patient lying on his back experiences pain while lifting his lower limb). The neurological examination performed in the diagnosis of the cauda equina syndrome consists in checking the patient's feeling and assessing their muscular strength. The reflexes should also be examined: in the course of the syndrome, the knee and ankle reflexes are abolished. The assumptions about the existence of the cauda equina syndrome can be confirmed by performing imaging tests. Depending on the suspected etiology of the disease, X-rays of the spine and magnetic resonance imaging (MRI) are used. X-ray allows, for example, to note traces of past fractures, detected during MRIin turn, cancer or infectious outbreaks may remain.
Cauda Equina Syndrome: Treatment
The choice of treatment for the cauda equina syndrome depends on what caused the compression of the lowest nerve roots. If the cause of the syndrome are infectious foci in the area of the spinal cord, patients are administered antimicrobials (e.g. antibiotics are used in bacterial infections). In patients whose syndrome is associated with a past injury, it is necessary to treat the injured area (including the removal of bone fragments). In some patients, an urgent neurosurgical operation is required. It is especially indicated when the symptoms of the cauda equina syndrome appeared suddenly, and their cause is, for example, a hemorrhage in the area of the spine or displacement of the intervertebral disc. These types of treatments are performed within 48 hours of diagnosis of the problem and are designed to decompress the horse's tail structures. Time is important here because postponing surgery could result in permanent destruction of the nerve roots of the horse's tail. Yet another therapeutic approach applies to those patients with the syndrome associated with neoplastic disease. If the lesion causing the cauda equina syndrome is operative, then its resection is performed at the scheduled time. In a situation where the tumor cannot be surgically removed (e.g. due to the risk of spinal cord injury), patients may receive radiotherapy.