Causes and Clinical Manifestations of Cauda Equina Syndrome

Chang Ju Hwang; Yung Tae Kim; Dong-Ho Lee; Choon Sung Lee; Jung Ki Ha; Tae Kyoon Lee

doi:10.4184/jkss.2013.20.4.204

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Hwang, Kim, Lee, Lee, Ha, and Lee: Causes and Clinical Manifestations of Cauda Equina Syndrome

Review Article

Journal of Korean Spine Surg 2013;20(4):204-209.

Published online: 21 December 2013

DOI: https://doi.org/10.4184/jkss.2013.20.4.204

Causes and Clinical Manifestations of Cauda Equina Syndrome

Chang Ju Hwang, M.D., Yung Tae Kim, M.D., Dong-Ho Lee, M.D., Choon Sung Lee, M.D., Jung Ki Ha, M.D., Tae Kyoon Lee, M.D.

Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea

Corresponding author: Chang Ju Hwang, M.D. Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea TEL: 82-2-3010-3530, FAX: 82-2-488-7877 E-mail: baski@amc.seoul.kr

Received 6 August 2013 Revised 30 September 2013 Accepted 27 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A literature review.

Objectives

To describe the causes and clinical characteristics of cauda equina syndrome.

Summary of Literature Review

The cauda equina syndrome, complex symptoms and signs expressed as variable clinical manifestation, has rare incidence but needs attention since it can bring about serious complications and sequales if neglected.

Materials and Methods

The Author reviewed articles reporting the causes and clinical manifestation of cauda equina syndrome.

Results

There are marked inconsistencies in the current evidence base surrounding the definition due to various clinical presentation of cauda equina syndrome.

Conclusion

As there is no symptom or sign which has an absolute diagnostic value in establishing the diagnosis of cauda equina syndrome, any patient in whom a clinical suspicion of cauda equina syndrome arises must undergo urgent magnetic resonance imaging for diagnosis.

Keywords: Cauda equina injury, Cauda equina syndrome, Cause, Definition, Clinical manifestation

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Figures and Tables%

Fig. 1.

Anatomy of the lower lumbar and sacral spine showing the cauda equina.

Fig. 2.

T2-weighted sagittal (A) and axial (B) MR image of 54 years old female patient with bladder dysfuction, motor weakness and sensory deficit of left leg, it shows a case of cauda equina injury by relapsed lumbar disc herniation after open discectomy.

Table 1.

Predictor value in diagnosing cauda equina syndrome by MRI

	Bell et al²³⁾	Balasubramanian et al²⁴⁾	Domen et al²⁵⁾
Diagnostic value (percentage)	22% (5/23)	19% (15/80)	14% (8/58)
Inclusion criteria of MRI	“significant cauda equina compression”	“canal compromise>75%”	“radiologist's evaluation reports”
Predictor	None	Saddle sensory deficit	Urinary retention>500mL or at least 2 of 3 symptoms*

*Bilateral sciatica, urinary retension, rectal incontinence

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