03 Nov Cauda Equina Syndrome
Back pain remains one of the most common conditions Physiotherapists treat and we certainly see it a lot at Halo! Serious complications of back pain are rare, and indeed it is estimated that only 1% of all back pain conditions are due to serious underlying pathology (CSAG; 1994).
One of the much rarer complications of back pain is Cauda Equina Syndrome.
The Cauda Equina is a bundle of spinal nerves which look like a horse’s tail (hence where the name comes from in Latin). The nerves extend from the bottom of the spinal cord, through the lumbar spine and over the sacrum, and down the back of each leg. The Cauda Equina provides innervation to the lower limbs and the sphincter, it controls the function of the bladder and bowel, and sensation to the skin around the back passage and the bottom.
The most common cause of Cauda Equina Syndrome is a prolapsed disc of the lumbar spine, but other conditions such as infection, tumour and spinal stenosis can also cause compression in this area. There is no agreed definition, but the British Association of Spinal Surgeons state that “a patient presenting with acute low back pain and/or leg pain with a suggestion of a disturbance of their bladder or bowel function and/or saddle sensory disturbance, should be suspected of having Cauda Equina Syndrome”. We know that most patients won’t have a critical cauda equina compression, but in the absence of reliable, predictive signs and symptoms, patients should have an MRI scan performed urgently.
Recent research has recommended that Physiotherapists and indeed all medical practitioners should be very clear and explicit in their questioning regarding Cauda Equina Syndrome. That is why we at Halo attribute a fair amount of time to taking a detailed subjective history in order that the physical examination and treatment is tailored to your needs. The Musculoskeletal Association of Chartered Physiotherapists (MACP) of which both Nicki Bradshaw and Laura Oxley are both full members, recommend using a credit card system that lists key symptoms to look out for if you are deemed at risk of developing the condition. We at Halo are therefore currently in the process of rolling out this system in our practice.
There are many other conditions that can mimic Cauda Equina Syndrome, and many medications also have side effects that can lead to a change in bladder and bowel behaviour – so please don’t be alarmed!
If you are concerned about such symptoms, it is important to be assessed by a Medical Professional. If back pain (with or without leg pain is getting you down), be sure to visit us at Halo for a full assessment and appropriate treatment as needed.
Blog compiled by Nicki Bradshaw, Senior Physiotherapist at Halo Physio