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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: 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.