Symptoms
The cauda equine, the collection of nerves where the spinal cord ends, is named for its resemblance to a horse's tail. According to the American Association of Neurological Surgeons, cauda equine syndrome (CES) is often misdiagnosed because the condition is not well known. CES occurs when the cauda equine nerve roots are compressed, causing sensory and motor dysfunction in the bladder and lower extremities. Patients are often admitted as medical emergencies with symptoms such as bowel or bladder dysfunction and problems in the lower extremities such as altered or lost sensation between the legs, over the buttocks, the back of the legs and inner thighs. The feet and heels can be affected as well, and often numbness, weakness or pain cause the patient to stumble or have difficulty rising from a chair.
Physical Exam
A physician will take a full medical history, including severity and onset of symptoms. Particular emphasis will be given to recent violent back injuries, lumbar surgery, severe infection or a history of cancer. According to the American Academy of Orthopaedic Surgeons, the doctor will assess the patient's sensation, strength, stability, alignment, reflexes and range of motion. She may ask the patient to walk, sit, stand, bend forward, backward and to each side, and lift the legs while in a prone position.
Diagnostic Testing
Blood tests may be ordered, as well as magnetic resonance imaging (MRI), X-rays, myleogram and computed tomography (CAT) scans in order to confirm the diagnosis of cauda equine syndrome. CES usually occurs after a lumbar disc is herniated due to a single excessive strain. However, a minor strain can incur damage in an already degenerated disc. Early treatment is vital in preventing permanent damage; cauda equine syndrome can cause permanent incontinence or permanent paralysis.
