Cauda Equina Syndrome- a tale of the horse’s tail

In my sports medicine and musculoskeletal(MSK) clinics I always have to be on the lookout for this rare condition called Cauda Equina Syndrome- CES. I see many patients with back pain and sciatica but fortunately the CES is rare. However if it is missed it can have devastating consequences for the patients due to long term nerve damage and resultant disability. Here I am going to explain what the condition is and which symptoms should prompt an urgent medical review.

Our spinal cord travels from the base of our brain all the way to our lower back- as the cord ends it forms a group of nerves that resemble a horse’s tail- cauda equina is latin for horse’s tail-hence the name.

Many patients develop low back pain and some may have pain being referred down their leg- this is often referred to as “sciatica”. The most common cause of this is a disc bulge in the lower spine that irritates or presses on one of the nerves as it exits from the spine. Symptoms may include referred pain into the leg, numbness, pins and needles or muscle weakness. Most cases settle with some physiotherapy, time and medications.

However if the pain affects both legs or numbness develops around the bottom/genital area this can be a sign of the more serious cauda equina syndrome.

Symptoms may include:

Loss of feeling/pins and needles between the inner thighs or genitals

Numbness in or around the back passage/buttocks

Loss of or altered sensation using toilet paper to wipe yourself

Increasing difficulty in starting to urinate

Loss of sensation passing urine or passing bowel motions

Incontinence of bladder or bowel control

Changes in ability to get or sustain an erection

Loss of leg control/weakness/stumbling

Should you develop any of these symptoms it is really important to see a doctor or other specialist as soon as possible- if in doubt then you should go to the A/E or emergency department for assessment. If needed an urgent MRI scan will be done and if this did show there was compression on the nerve roots then urgent surgery would be performed. This MRI image below shows a large disc bulge causing cauda equina syndrome.

If in doubt always get yourself checked as without treatment it can cause permanent nerve damage to the legs and control of bowel/bladder function. Fortunately it is rare- as a doctor for 25 years I have seen about 2 or 3 cases either from the complications or as a new diagnosis. Normally back pain and sciatica in one leg is treated well without the need for surgery- with time, physio, rehab and medications.

Please do always remember the tale of the horse’s tail if ever in doubt.

Dr Michael S.Burdon

Consultant in Sport, MSK and Exercise Medicine

19th March 2021

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