" Time Is Spine " - Spine Awareness Article on Cauda Equina Syndrome by Dr Krishna Kumar R , Spine & Scoliosis Surgeon
( Unedited version of the article published in The New Indian Express 18/7/2023 )
TIME IS SPINE
"Doctor we have a situation in emergency room", I received a call as I was scrubbed up for an elective spine surgery.. There was a lady in her late 20s brought to emergency room with severe back pain, weakness of both legs and not able to pass urine and constipated for about 10 days...
She was being treated at a government teaching hospital in another district for about 2 weeks; admitted for 10 days and her condition just didn't improve; in fact it worsened to a stage that she was in a very critical situation-weak legs, bedridden and on urinary tube with severe pain...
If one can pinpoint a diagnosis with the cluster of these symptoms ie acute severe back pain with weakness and numbness of legs with urinary bladder and bowel involvement( urinary retention and constipation), it is a serious condition affecting the spinal nerves known as acute cauda equina syndrome..
I know that sounds too complicated ; cauda equina in Latin means 'pony tail' or tail of a horse. During the era when medical science was evolving and they were trying to understand the human body and its anatomy, the scientists explored the spine and found a bunch of nerves at the end of the spinal cord which looked quite similar to ponytail so they named it as cauda equina.
This group of nerves originate at the end of the spinal cord at the lower back or the lumbar spinal region, which goes down to both the legs as. sciatic nerve and also goes to the muscles of urinary bladder , urinary sphincter, sexual organs, anal canal and anal sphincter muscles.
In short, theses nerves carry signals to and from brain through spinal cord to the pelvic organs ( bladder, bowel sexual organs) and legs.
So when these nerves are compressed due to a number of causes such as herniated or prolapsed intervertebral disc, infection ,fractures, tumour , cancer etc; the above mentioned organs are at risk.
Patient would experience acute severe low back pain, sciatica (a pain radiating from the back through the buttocks to the legs either on one leg or both legs), pain with difficulty in walking due to weakness of legs and bubble and bladder involvement.
Another classic feature of this condition is known as "saddle anaestasia" or "saddle nubness"-which means the patient would complain of significant numbness or altered sensation in the undergarment area - buttocks, in between the legs and sexual organs.
Men would complain of loss of erection or erectile dysfunction.
How is this condition diagnosed?
From the history of the patient, clinical examination and by investigation such as MRI scan which can detect the cause of the nerve compression .
Why time is important in Spine Disorders?
Cauda Equina syndrome is a spinal emergency condition and compressed nerves have to be relieved off the pressure by an early spine surgery. If not, the nerves could be permanently damaged resulting in permanent paralysis of the muscles of the legs,bladder and bowel. Sometimes the initial assault on the nerves due to the compression is so severe that even an early surgery would take a long time for the patient to recover.
Right diagnosis and treatment at the right time plays a major role in spinal disorders.
In spite of high literacy rate, many people lose valuable time by delaying or postponing timely treatment; thereby landing in serious complications which may cause irreversible spinal nerve damage.
It may be prudent to note that postponing the treatment would not cure many of the spinal problems
The patient mentioned earlier underwent emergency spine surgery, and it took almost 1 year for the patient to completely recover. Now 7 years down the line she is absolutely normal.
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*RED FLAG SIGNS* OF CAUDA EQUINA SYNDROME
Seek urgent medical help if you experience any of the following
Sudden severe back pain, bilateral leg pain(Sciatica),
weakness of one or both legs.
Saddle numbness urinary bladder issues
such as inability to control urine, no sensation while passing urine, involuntary urination , loss of feeling fullness of bladder
Bowel Dysfunction - Unable to control bowel movements,
Constipation ,
Loss of feeling of Bowel movements.
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Author
Dr Krishna Kumar R is the Head of the Department of Spine Surgery at Medical Trust Hospital,
Scoliosis Research Society (USA)- Robert Winter Fellowship Recepient .
https://www.newindianexpress.com/cities/kochi/2023/jul/18/time-is-spine-know-more-about-cauda-equina-syndrome-2595791.html
