Cauda equina syndrome is a serious neurological condition that can have a significant impact on a person's quality of life. The condition can severely disrupt a person's physical abilities, mobility, and bowel, bladder and sexual function if it is not properly treated. 

In this blog post, we will shed light on the prevalence of cauda equina syndrome and the difficulties that are sometimes associated with diagnosing the condition correctly.

What Is Cauda Equina Syndrome?

Cauda equina syndrome is characterised by compression of the cauda equina nerves, a bundle of nerve roots situated at the lower end of the spinal cord. These nerve roots play a crucial role in controlling and managing sensation in the lower body, including bladder and bowel function, as well as motor control in the legs.

This compression can be caused by various conditions or events, including a herniated spinal disc, spinal stenosis (narrowing of the spinal canal), a spinal injury, complications from lumbar spine surgery, or a tumour in the spine. When this happens, it causes the patient to lose function in their lower extremities, resulting in several debilitating symptoms, including:

• Bladder and bowel dysfunction, including altered sensation, not feeling the urge to go to the toilet, incontinence and constipation, and a loss of control over bladder function
• Sexual dysfunction, including a loss of sensation
• Chronic pain, numbness and altered sensation in one or both legs, and the lower body more generally
• A loss of power in the legs

Many of these symptoms are long-lasting and life-changing, which is why it is so important to ensure that the condition is diagnosed promptly and treated correctly.

Is Cauda Equina Syndrome Rare?

The following statistics offer an indication of cauda equina syndrome prevalence:

Data from the NHS suggests that cauda equina syndrome occurs in one to three in every 100,000 people in the UK

• Figures quoted by the British Association of Spine Surgeons suggest that the condition is rarer than this, affecting between six and 10 people per million
• According to the Chartered Society of Physiotherapy (CSP), up to two people in every 100 with herniated lumbar discs may develop the condition
• The CSP also states that about 10 per cent of people who show signs and symptoms of cauda equina syndrome actually have the condition
• Research led by South Essex University Hospitals and The Essex Spine Centre shows that cauda equina syndrome accounts for around two to six per cent of lumbar disc operations
• According to the same study, UK GPs are unlikely to encounter a true case of cauda equina syndrome caused by intervertebral disc herniation in their entire career

All of these figures are estimates, and the actual incidence may be higher or lower.

Does Cauda Equina Syndrome Affect Life Expectancy?

Cauda equina syndrome does not typically affect a person’s life expectancy directly, as it is not a life-threatening condition in itself. However, the long-term impact on quality of life can be significant, depending on the severity of the condition, the timing of diagnosis, and the effectiveness of treatment. Some of the associated complications of CES can indirectly impact long-term health. For example:

• Infections: bladder or kidney infections, resulting from urinary retention or incontinence, can become serious if not properly treated.
• Mental health challenges: depression, anxiety, or emotional distress caused by the loss of function or independence can increase health risks over time if not addressed.
• Lifestyle limitations: reduced mobility or chronic pain can lead to a sedentary lifestyle, increasing the risk of cardiovascular disease or other chronic conditions.

Why Is it Important to be Vigilant About Cauda Equina Syndrome?

The broad range of potential symptoms can initially appear similar to other conditions, such as general back pain or sciatica, which are less severe but much more common. As a result, cauda equina syndrome can sometimes be missed or misdiagnosed, leading to delays in treatment. This can have serious consequences for patients, as acute cauda equina syndrome can develop rapidly, meaning there is only a small window of opportunity to carry out surgical decompression of the nerve roots and avert the worst damage the condition can cause.

As such, medical professionals have a responsibility to be vigilant about cauda equina syndrome and be aware of the red flag symptoms to look out for. If a patient presents with any potential neurological signs, such as altered sensation, urinary or bowel changes, or weakness, they must be assessed thoroughly to rule out the possibility of cauda equina syndrome. An accurate diagnosis is typically achieved through a magnetic resonance imaging (MRI) scan, which can identify any compression of the cauda equina nerves around the spinal cord. Once diagnosed, urgent surgery can be scheduled to decompress the nerves and prevent the condition from developing further.

If a medical professional fails to correctly diagnose cauda equina syndrome in its early stages, it will result in the patient potentially developing long-term disabilities, losing the ability to control their bladder and bowel, losing their sexual function, or struggling with chronic pain. It is therefore vital that healthcare providers keep the signs and symptoms of cauda equina syndrome in mind and take any potential cases seriously.

What Is Involved in Cauda Equina Syndrome Treatment?

Treating cauda equina syndrome focuses on alleviating the pressure on the cauda equina nerves, preserving nerve function, and preventing irreversible harm to the patient’s mobility, bowel, bladder and sexual function.

This requires a prompt and accurate diagnosis which typically involves:

• A clinical examination to assess symptoms, including neurological and sensory changes.
• An MRI scan, which is the gold standard for identifying nerve compression or other spinal abnormalities.

Time is of the essence, as delays in diagnosis and treatment can lead to severe and lasting damage.

The most effective treatment for cauda equina syndrome is surgical decompression, typically a laminectomy or discectomy, depending on the underlying cause.

Surgery aims to relieve the pressure on the cauda equina nerves and must ideally be performed within 24-48 hours of the onset of severe symptoms to maximise the likelihood of recovery.

Post-Surgical Care and Rehabilitation

Once the pressure on the nerves has been relieved, the focus shifts to managing symptoms and helping the patient regain function. This may involve:

• Physiotherapy to improve mobility, strength and balance in the lower limbs. Tailored exercises can aid in rebuilding motor function and preventing muscle atrophy.
• Bladder and bowel management if urinary or bowel dysfunction persists, patients may need support, such as catheterisation, bowel retraining, or medications to manage symptoms.
• Pain management such as medications (e.g., analgesics and neuropathic pain relievers) or other interventions, such as nerve stimulation or pain management clinics.
• Sexual rehabilitation via support from specialists, including urologists, gynaecologists or counsellors, may be necessary.
• Psychological support including counselling or therapy can help patients adjust to the changes in their lives.

The success of CES treatment largely depends on how quickly the condition is diagnosed and addressed. Delays in treatment increase the likelihood of permanent damage, including:

• Chronic pain
• Loss of bowel and bladder control
• Irreversible motor or sensory deficits

Even with prompt intervention, patients may experience residual symptoms, requiring long-term management and adaptations to their daily lives.