Duke Orthopaedics
Wheeless' Textbook of Orthopaedics

Cauda Equina Syndrome

- Anatomy:
    - subarachnoid space is prolonged in a duralarachnoid sheath around each dorsal and ventral root, roughly to level of union of roots;
    - because the cord is shorter than vertebral column, nerves slope inferiorly from their levels of origin to appropriate intervertebral foramina, and the
             angle becomes more acute from above downward;
    - below inferior end of cord, dural-arachnoid sac contains leash of nerve roots and the filum terminale;
            - this complex constitutes the cauda equina;

- Cauda Equina Syndrome:
    - most often caused by central disk herniation at the L4-5 (L5 nerve root) or L5-S1 levels (S1 root)
    - urinary retention is the most consistent finding;
           - see urologic management of the spinal cord injured patient
    - in spinal cord injuries, the caudal equina may sustain considerable initial trauma & stop functioning, but there may be a good prognosis for partial cauda injuries;
    - in any potential cauda equina syndrome it is important to examine for saddle anesthesia, rectal tone, bulbocaverosus reflex, and sacral sparing

1991 Volvo Award in experimental studies. Cauda equina syndrome:  neurologic recovery following immediate, early, or late decompression.

Arterial vascularization of the cauda equina.

Outcome of laminectomy for civilian gunshot injuries of the terminal spinal cord and cauda equina: review of 88 cases.

Cauda equina syndrome and lumbar disc herniation.

Cauda Equina Syndrome

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, December 27, 2011 4:22 pm

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