Pain in the lower back affects millions of people around the world, and in most cases, it goes without treatment for surgical intervention. However, severe pain in the back can be a symptom of serious illness that often goes undiagnosed. Cauda equina syndrome occurs in the case of compression (compression), the nerve roots and there was dysfunction of the lower limbs and bladder. Such patients often come to the hospital in urgent situations. Cauda equina syndrome can lead to incontinence and even temporary paralysis of the legs.
Ponytail - a bundle of nerve roots of the finite parts of the spinal cord - from the first lumbar segment below. Its name, this beam has a resemblance to a horse's tail. Ponytail - a continuation of the nerve roots of the spinal cord, which begins, as already mentioned, in the lumbar segments. These nerve roots responsible for innervation of the lower limbs and pelvic organs (bladder).
The causes of cauda equina syndrome
The most common cause of cauda equina syndrome - a hernia of the intervertebral disc in the lumbar spine. Herniated intervertebral disc may be due to excessive stress or trauma. In addition, marked degenerative processes of aging in the intervertebral disc and ligaments weaken. As the progression of these processes is relatively small load can cause rupture of the disc.
Other causes of cauda equina syndrome:
injury and spinal cord tumors;
infectious and inflammatory processes spinal cord;
narrowing of the lumbar vertebrae;
severe lower back injury (gunshot wounds, falls, car accident);
congenital anomalies;
arteriovenous malformation of the spinal cord;
hemorrhage in the spinal cord (subarachnoid, subdural, epidural);
complications after operations on the lumbar spine;
spinal anesthesia.
Symptoms and diagnosis of cauda equina syndrome
The manifestations of cauda equina syndrome may be different in intensity and eventually they become stronger. Symptoms of envy on the degree of compression of nerve roots and from what roots are compressed. In addition to a herniated disc, cauda equina syndrome manifestations observed in conditions such as peripheral nerve pathology (ie, sciatic, femoral, and other nerves) syndrome, conus medullaris, spinal cord compression, inflammation, or compression of the nerves after they came out of the vertebral column, as well as the lumbosacral pleksopatiya.
Patients with pain in his lower back should be alert for the appearance of these "iconic" signs:
severe pain in his lower back;
muscle weakness, numbness or pain in one or both lower extremities; "Saddle anesthesia" - the lack of sensitivity in the feet, which corresponds to when sitting in the saddle;
dysfunction of the bladder (incontinence or urinary retention);
constipation;
sensory disturbances in the bladder or rectum;
sexual disorders;
loss of reflexes in the legs.
Prior cauda equina syndrome status:
recent severe back injury;
recent surgery of the lumbar spine;
malignant tumors;
recent severe infections.
Diagnosis of cauda equina syndrome
In the diagnosis of cauda equina syndrome is essential:
Magnetic resonance imaging - a type of study, allowing a cross-sectional images of internal organs with very high accuracy. It is based on human exposure by electromagnetic waves in a strong magnetic field, after which the electromagnetic radiation is recorded. Further, it is processed by a computer.
Myelography - X-ray method for studying spinal cord and its structures. It lies in the fact that in the spinal canal is entered dye, and then carried out an X-ray spine. This method allows to determine the presence of intervertebral hernia and other structures that compress the nerve roots.
Treatment of cauda equina syndrome
Once a diagnosis of cauda equina syndrome, and determined its cause, is usually carried out urgent surgical intervention. The goal of surgery is to eliminate the symptoms. If you do not intervene in time, there is a risk of permanent paralysis and dysfunction of the bladder and rectum.
In the event of "iconic" signs should immediately contact a neurosurgeon. In these cases, the best method of treatment is urgent surgical intervention. Treatment within the first 48 hours after the start of the syndrome is a considerable advantage in eliminating the symptoms of deterioration of sensitivity and motor functions, and functions of the bladder and rectum. And even if the operation is carried out within 48 hours after the onset of the disease may notice an improvement.
Although the recovery of bladder function may be delayed compared with the restoration of motor functions of legs, with time for several years, it is also normal. Drug therapy after surgery contributes to a gradual slow recovery of the lost functions of the organs of the pelvis. Surgery for cauda equina syndrome is careful selection of the nerve root adhesions. This so-called neurolysis surgery.
