- 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.
Cauda equina syndrome: is the current management of patients presenting to district general hospitals fit for purpose? A personal view based on a review of the literature and a medicolegal experience.