cauda equina syndrome
TRANSCRIPT
5th most common condition
~25% adults report LBP w/in past 3 months
Prevalence of 70% over the course of one’s life
>85% cannot be reliably attributed to a specific disease or abnormality
Classified into 3 broad categories:
1. Nonspecific LBP
2. Nerve Root Syndrome (CES, etc.)
3. Serious Spinal Pathology
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Less common than nonspecific
Potentially disabling condition
Most often caused by acute lumbar disc herniation
Commonly between ages of 30 – 55
Related to:
Radiculopathy
Spinal Stenosis
Cauda Equina Syndrome
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Rare and devastating condition
Prevalence of ~0.04% of all patients presenting w/ LBP
“True neurologic emergency”
Rapid clinical progression
For optimal prognosis:
Early recognition/diagnosis
Immediate surgical referral
Recommended w/in 48 hours of Dx
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32 year old male presented to a PT at a medical aid station in Iraq.
Convoy machine gunner
Prolonged periods of standing >8 hrs
Wearing equipment up to ~80 lbs
4 week history of insidious onset and recent worsening of:
Low back pain
Left buttock pain
Posterior left thigh pain
Goal: Decrease pain during work
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Pain: 4/10 resting and 7/10 at worst
Hx: 3-4 prior occurrences of LBP
Physical Exam:
Neurologically intact, and negative SLR
Limited lumbar flexion AROM
Reduction of Sx w/ lumbar extensions
Findings consistent w/ nonspecific LBP
No red flag signs or symptoms
Treatment:
Prescribed extension-oriented exercises
Prescribed NSAIDs for pain
Patient education
New Symptoms:
Saddle anesthesia, LE paresthesia constipation, and urinary hesitancy.
Physical Exam:
Right plantar flexor weakness, absent right ankle reflex, and decreased anal sphincter tone.
Findings consistent w/ CES
Referral:
Medically evacuated to neurosurgeon
L4-5 Laminectomy/decompression w/in 48 hours of CES diagnosis
Returned to full military duty 18 weeks after surgery without back or lower extremity symptoms or neurological deficits.
Demonstrates the importance of medical screening.
Demonstrates the importance of immediate referral to surgical specialties when CES is suspected.
Rapid intervention offers the best prognosis.
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Spinal cord ends between vertebrae L1 & L2
Originates after Conus Medullaris
L2 to S5 nerve roots looks like horse’s tail
Includes motor nerves, sensory nerves and parasympathetic innervation of the bladder
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Compressive causes
Herniated lumbosacral disc
Spinal stenosis
Spinal neoplasm
Fracture of vertebrae
Non-compressive causes
Ischemia
Infection
inflammation
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Making a thorough evaluation
Continually monitoring patient’s status throughout the patient management
Acting appropriately when conditions emerge that requires immediate referral
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