Case study 21 - Cauda Equina Syndrome from a large lumbar disc herniation - EXPLAINED by a surgeon скачать в хорошем качестве

Case study 21 - Cauda Equina Syndrome from a large lumbar disc herniation - EXPLAINED by a surgeon

Case study 21 #backpain #neurosurgery #spinesurgery #chiropractor #caudaequinasyndrome #spineemergency The collection of nerves at the end of the spinal cord is known as the cauda equina, due to its resemblance to a horse's tail. The spinal cord ends at the upper portion of the lumbar (lower back) spine. The individual nerve roots at the end of the spinal cord that provide motor and sensory function to the legs and the bladder continue along in the spinal canal. The cauda equina is the continuation of these nerve roots in the lumbar and sacral region. These nerves send and receive messages to and from the lower limbs and pelvic organs. Cauda equina syndrome (CES) occurs when there is dysfunction of multiple lumbar and sacral nerve roots of the cauda equina. CES is accompanied by a range of symptoms, the severity of which depend on the degree of compression and the precise nerve roots that are being compressed. Patients with CES may experience some or all of these “red flag” symptoms. Urinary retention: the most common symptom. The patient’s bladder fills with urine, but the patient does not experience the normal sensation or urge to urinate. Urinary and/or fecal incontinence. The overfull bladder can result in incontinence of urine. Incontinence of stool can occur due to dysfunction of the anal sphincter. “Saddle anethesia” sensory disturbance, which can involve the anus, genitals and buttock region. Weakness or paralysis of usually more than one nerve root. The weakness can affect lower extremities. Pain in the back and/or legs (also known as sciatica). Sexual dysfunction. If a patient is experiencing any of the “red flag” symptoms above, immediate medical attention is required to evaluate whether these symptoms represent CES. Treatment Once the diagnosis of CES is made and the etiology established, urgent/emergent surgery is usually the treatment of choice. The goal is to free up the compressed nerve roots and give them the best chance of recovery possible. Left untreated, CES can result in permanent paralysis and incontinence. Those experiencing any of the red flag symptoms should be evaluated by a neurosurgeon or orthopedic spine surgeon as soon as possible. Prompt surgery is the best treatment for patients with CES. Treating patients within 48 hours after the onset of the syndrome provides a significant advantage in improving sensory and motor deficits as well as urinary and rectal function. Even patients who undergo surgery after the 48-hour ideal time frame may experience improvement. Although short-term recovery of bladder function may lag behind reversal of lower extremity motor deficits, the function may continue to improve years after surgery. Following surgery, drug therapy coupled with intermittent self-catheterization can help lead to a slow, but steady, recovery of bladder and bowel function. Coping with CES Follow-up with the patient’s surgeon occurs a few weeks after surgery to check healing and progress. Many of these patients also require long term follow-up with rehabilitation medicine. Cauda Equina is a relatively rare condition and therefore data on long term outlook is limited. CES can affect people both physically and emotionally, particularly if it is chronic. People with CES may no longer be able to work, either because of severe pain, socially unacceptable incontinence problems, motor weakness and sensory loss – or a combination of these problems. Loss of bladder and bowel control can be extremely distressing and have a highly negative impact on social life, work and relationships. Patients with CES may develop frequent urinary infections. Sexual dysfunction can be devastating to the patient and his/her partner and may lead to relationship difficulties and depression. Severe nerve-type (neurogenic) pain may require prescription pain medication with side effects that may cause further problems. If the pain is chronic, it may become "centralized" and radiate to other areas of the body. Neurogenic pain tends to be worse at night and may interfere with sleep. This type of pain tends to produce a burning feeling that can become constant and unbearable. Sensory loss may range from pins and needles to complete numbness, and may affect the bladder, bowel and genital areas. Weakness is usually in the legs and may contribute to problems walking. It is essential that people with CES receive emotional support from a network of friends and family members, if possible. It is important to work closely with your physician on medication and pain management. There are several medications prescribed to address pain, bladder and bowel problems. In addition, some patients find that physical therapy and psychological counseling help them cope with CES.