Spine lecture spinal cauda equina syndrome

1. Cauda Equina Syndrome
• Upper Chesapeake medical Center Spine
Conference
• Friday June 2nd, 2017

2. 39 year old woman
Cc: B sciatica perineal
anesthesia
HPI: 2 weeks of symptoms,
she thought it was MS
PMH: bipolar, gastic sleeve
120/40 2014,
SH: disability, lives alone

4. L3L4
L4L5

5. L5S1

6. Note the R S1 nerve root

7. Typical L5S1 disc herniation

9. cauda equina

10. Cauda Equina Syndrome

11. Pain
saddle anesthesia
sacral nerve root
dysfunction

17. Bladder/Urination symptoms
Lack of bladder fullness sensation
Urinary retention
Urination down thigh in women
Overflow incontinence

20. Spine 2000 meta-analysis
322 patients
chronic LBP worse B/B
bowel dysfunction worse urinary
older age worse sex function
<24 hours no better than 24-48 hours
all patients have same outcome >48
hours
significant difference in B/B function
and sensation for patients <48 hours
and >48 hours

23. • B S1-S5 100% (bowel/bladder loss)
• B S2S5 100%
• B S3S5 60%/75%
• B S4S5 0%/40%
• Unilateral S3 33%/40%

26. Nicholas Vyner Todd, UK neurosurgeon,
Newcastly upon Tyne, UK
Categories:
1. Suspicious
2. Incomplete
3. Retention (urinary)
4. Complete
Br J Neurosurgery 2016 review article
158 papers
<24 hours surgery 89% normal bladder
<48 hours surgery 79% normal bladder
>48 hours surgery 44% normal bladder
Emergency MRI critical for suspicious patients
B sciatica is suspicious
Incomplete bladder dysfunction patients are
true emergencies
“out of hours” surgery carry increased
morbidity and mortality

27. Shanghai, china

28. Early: B symptoms lower extremity m/s
incomplete
retention

29. BLE pain
BLE
paresthesia
B motor LE
B sciatica
Perineal
paresethsia
Perineal pain
Reduction
bladder
Reduction
bowel
Bladder
dysfuction
Bowel
dysfunction
222 cases

31. Thanks