Cauda Equina Syndrome Treatment

The spinal cord ends near the first lumbar vertebra in the lower back, forming the conus medullaris. The fibrous extension of the spinal cord is the filum terminale. The buncle of nerve roots below the conus medullaris is named the cauda equine.
Compression or inflammation of the nerve roots can cause symptoms of pain, altered reflexes, decreased strength, and decreased sensation. Although these symptoms can become severe, and in some cases disabling, most are self-limiting and respond to conservative care.
An extreme version of nerve compression or inflammation is cauda equine syndrome. Cauda equina syndrome is a serious condition caused by compression of the nerves in the lower portion of the spinal canal (see Multimedia File 2). Cauda equina syndrome is considered a surgical emergency because if left untreated it can lead to permanent loss of bowel and bladder control and paralysis of the legs.
Cauda Equina Syndrome Causes
Cauda equina syndrome is caused by significant narrowing of the spinal canal that compresses the nerve roots below the level of spinal cord. Numerous causes of cauda equina syndrome have been reported, including traumatic injury, disk herniation, spinal stenosis, spinal tumors (neoplasms), such as metastatic tumors, meningiomas, schwannomas, and ependymomas, informatmatory conditions, infectious condtions, and accidental causes by medical intervention (iatrogenic causes).
In many cases of cauda equina syndrome, emergency decompression of the spinal canal is the best treatment option. The goal is to relieve pressure on the nerves of the cauda equina by removing the compressing structures and increasing the space available for the nerves in the spinal canal. Traditionally, cauda equina syndrome has been considered a surgical decompression considered necessary within 48 hours of the onset of symptoms.