The nerve bundle at the lower end of the spinal cord is called the cauda equina. Means “horse tail” in Latin. It was given this name because of its shape. The cauda equina nerves provide communication between the legs and organs in the pelvic region and the brain. If these nerve roots are compressed, cauda equina syndrome occurs. It is a rare condition that occurs in 1 to 3 in 100,000 people. If left untreated, it can lead to permanent problems. It gives signs and symptoms such as low back pain, pain radiating down the leg, loss of bladder and bowel control, numbness in the anus area. The development of the disease can be rapid or slow.
Usually, the bladder and legs are the first sites to be affected in cauda equina syndrome. There may be trouble holding urine and urinating (incontinence). Pain or loss of sensation may occur in the legs, buttocks, feet, and heels. Sensory changes occur most in what is known as the “if zone”. This is the place where the person touches the saddle while riding. If left untreated, symptoms worsen over time.
Severe low back pain, weakness in one or both legs, loss of pain or sensation, incontinence, loss of reflexes in the legs, sexual dysfunction are important symptoms that can be seen in cauda equina syndrome.
The most common cause is herniated disc (disc hernia). Between the bones of the spine are discs that are soft like pillows and absorb shock. While the inside of the disc is soft, the outer wall is hard. If the outer hard fibers are torn, the soft inner part may overflow and compress the surrounding nerve fibers. Lumbar hernia is more common in overweight and obese people, those who work in jobs that require heavy lifting and carrying, those who have a genetic predisposition, and those who have suffered injuries such as serious falls or traffic accidents.
Other causes of cauda equina include tumors in the lower part of the spinal cord, spinal cord infection or inflammation, spinal stenosis (duct stenosis), congenital abnormalities, and surgical complications.
Diagnosis is made by questioning the complaints, physical examination and imaging techniques. In the examination, muscle strength, reflexes and sensory sensations in the legs are evaluated. Movements and maneuvers such as standing up, sitting, walking on heels and toes, raising the legs while lying on the back, bending from the waist to the front, back and sides can be performed. Depending on the nature of the complaints, anal tone and sensation may need to be examined. Lumbar MRI (lumbar vertebra MRI) provides visualization of discs and nerve roots.
Once cauda equina syndrome is diagnosed, treatment usually requires surgery. If the nerve roots are compressed due to the hernia, the pressing disc is removed. Surgery is recommended within 24-48 hours in cases with sudden loss of strength, sensation or reflex loss in the legs, urinary or stool incontinence, and severe low back pain. Otherwise, irreversible nerve damage may occur and paralysis may develop. During the post-operative recovery period, physical therapy and rehabilitation are applied to restore the person’s functions such as walking, muscle strength and balance. Drug treatments can be given for complaints such as pain, contraction, urinary incontinence.