Reviewing the Definition of Cauda Equina Syndrome
While only one out of 2000 patients are diagnosed with cauda equina syndrome, it is diagnosed in one percent to 16 percent of patients who have lower back (lumbar) disk herniations (bulging or slipped disks) and in two percent to three percent of patients who end up needed surgery for the herniated disks.
Cauda equina syndrome, if left undiagnosed, may cause a lot of damage. It can cause loss of bladder or bowel control, and it can affect sexual function. Unfortunately, because the syndrome isn't seen very often in every day practice, it may slip past a doctor undiagnosed. For this reason, the authors of this article wanted to review the signs and symptoms of caudal equina syndrome and how to identify it.
Researchers searched through the medical literature looking for articles about cauda equina syndrome. They identified 111 articles but had to discard six, leaving them with 105.
Interestingly, the researchers found 17 different definitions of cauda equina syndrome within the articles. Nine defined it by how it was caused while the other nine by the way it showed up. They also found 14 different pathologies or beliefs of what caused the syndrome.
There were also many different descriptions of how the syndrome presented:
- 10 involved the bowels
- 6 involved pain
- 5 involved sexual dysfunction
The study authors also described the physical aspects differently:
- 7 involved sensory issues
- 10 involved power
- 7 involved reflexes
There is also a difference between complete and incomplete cauda equina syndrome, as described by one of the studies by Gleave and Macfarlane. They felt that it was extremely important to point this out. The defined incomplete cauda equina syndrome as "a patient with urinary difficulties, altered urinary sensation, loss of desire to void, poor urinary stream, and the need to strain to [urinate]." On the other hand, complete cauda equina syndrome was "painless urinary retention and overflow incontinence."
In conclusion, the authors of this article suggest that it is necessary for more to be done in defining cauda equina syndrome. They write that doctors should ask patients about any problems with bladder or sexual activity and monitor any bowel issues. As well, they should pay special attention to the saddle area and the genital area for changes in sensation. Finally, if there is any suspicion of cauda equina syndrome, they must take quick action to prevent further injury.
Stuart Fraser, BSc, Lisa Roberts, PhD, and Eve Murphy, MSc. Cauda Equina Syndrome: A Literature Review of Its Definition and Clinical Presentation. In Archives of Physical Medicine and Rehabilitation. November 2009. Vol. 90. Pp. 1964 to 1968.