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Cauda Equina Syndrome

Cauda equina (“horse’s tail”) syndrome, also known as CES, is a rare neurological disorder affecting the group of nerve roots at the bottom of the spinal cord. These nerve roots are responsible for the neurological functioning of the legs, feet, bladder, bowels and pelvic organs. Left untreated, cauda equina syndrome can result in permanent urinary or fecal incontinence, sexual dysfunction or paralysis.

What Causes Cauda Equina Syndrome?

Most frequently, CES occurs because of disc herniation which may be a consequence of normal aging. Apart from lumbar disc herniation, CES may occur as a result of:

  • Birth defects
  • Spinal stenosis
  • Lesions or tumors
  • Infection of the spine
  • Spinal injury

CES most often occurs in adults. When it presents in children, it is usually the result of a birth defect or traumatic spinal injury.

Symptoms Of Cauda Equina Syndrome

Since CES has symptoms in common with several other disorders, it may be difficult to diagnose. In order to make a definitive diagnosis, imaging tests such as CT scans, MRIs and myelograms must be administered. The symptoms of CES may include:

  • Weakness in one or both legs
  • Pain or numbness in lower back, legs, buttocks, inner thighs, groin
  • Urinary or fecal incontinence
  • Urinary or fecal retention
  • Sudden sexual dysfunction

One of the symptoms of CES in called “saddle anesthesia,” indicating the patient’s inability to feel the parts of the body that would make contact with the saddle during horseback riding. When the symptoms of CES manifest suddenly, emergency surgery is typically necessary.

“I wouldn’t be walking today without him. Dr. Girardi has the most gentle bed side manor , takes his time to answer any question you have big or small and most of all LISTENS! I can’t thank him enough … he’s guided me through 5 major Lumbar fusions so I can honestly say we have had a long history together. Hospital for Special Surgery and i were very lucky to have him because he is just pure genius in the O.R.” – Alisha S.

Cauda Equina Syndrome Treatment

Cauda equina syndrome must be treated as quickly as possible in order to maintain normal functioning in the lower body. Without prompt treatment, the patient may suffer permanent neurological damage. It is imperative that crucial spinal nerves be decompressed to prevent permanent paralysis, sexual dysfunction or incontinence. Currently, the most effective remedy for the condition is surgery, usually a discectomy in the lumbar spine. Such a procedure normally takes care of the

problem. In cases where there is severe inflammation in the area, corticosteroids may also be administered. In cases where there is infection present, antibiotics will be prescribed.

Cauda Equina Syndrome Recovery

In cases where surgery is successful, patients experience gradual improvement until they have regained complete function, although full recovery may take from several months to several years. Whether the surgery is successful usually depends on how severe the nerve damage has been and on how long it has remained untreated. In most cases, permanent damage is the result of either a sudden traumatic injury or a problem that has been neglected for too long a period of time.

At a Glance

Dr. Federico Girardi MD

  • Triple fellowship-trained spinal surgeon
  • Performs over 400 spinal surgeries per year
  • Professor of orthopedic surgery at Cornell University
  • Learn more

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