Cauda Equina Syndrome its clinical feature and managerct.pptx

Cauda equina syndrome is an orthopedic emergency. It must be managed timely to prevent Complete bowel and bladder dysfunction. The symptoms are severe backache radiating to legs , bowel and bladder dysfunction and impotence including Saddle anesthesia. Immediate decompreSsion is required for treatment

1. Cauda Equina syndrome Presented by, Rakesh Yadav (40) Rita K.C. (41) Rohit Kumar Jha (42)

2. CONTENTS Anatomy Introduction Epidemiology Etiology Clinical Features Diagnosis Treatment

3. Anatomy of C auda Equina Latin- Horse tail Collection of L1-S5 peripheral nerves within lumbar canal surrounded by dural sac Spinal cord ends at L1-L2 level

4. Cauda equina syndrome Lower motor neuron lesion Clinical diagnosis resulting from dysfunction of one / more of sacral root S2 and below. One or more of following symptoms must be present, a. Bladder and/ bowel dysfunction b. Reduced sensation in saddle area c. Sexual dysfunction 4 https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://pmc.ncbi.nlm.nih.gov/articles/PMC8782783/&ved=2ahUKEwj3me6pjJePAxW5ia8BHewaH2AQFnoECBkQAQ&sqi=2&usg=AOvVaw3CKis9P6qqKbzH1tbYzPMb

5. Epidemiology An annual incidence of approximately 1.5 to 3.4 per million people (i.e., about 0.15–0.34 per 100,000 per year ) Prevalence 1 in 30,000 to 100,000 people per year CES occurs in around 3% of all disc herniations https ://www.ncbi.nlm.nih.gov/sites/books/NBK537200/?utm_source=chatgpt.com 5

6. Central disc herniation Disc Prolapse Spinal stenosis Infection Trauma Iatrogenic Etiology

7. Bowel and bladder dysfunction

8. Types Name Abbreviation Definition Suspected CES CESS No bladder/bowel/genital/ perineal symptoms, but bilateral sciatica or motor/sensory loss in legs. (this is clinical CESS) Or known large disc herniation on existing MRI (this is radiological CESS) Symptom-only CES (early CES) CESE Normal bladder, bowel and sexual function but some sensory loss in perineum or change in micturition frequency Incomplete CES CESI Alteration in bladder/urethral sensation or function, but maintenance of executive bladder control  + / −  perineal sensory changes, or sexual or bowel sensory or functional changes CES with retention CESR As in 3 but with painless bladder retention and overflow Complete CES CESC Insensate bladder with overflow incontinence, no perineal perianal or sexual sensation, no anal tone

9. Investigations MRI (study of choice) CT Myelography Urinary studies (PVR volume) Blood- ESR, CRP DRE (to check anal tone and perianal sensation)

10. Management Neuros urgical emergency Immediate measures Early surgical decompression with removal of fragments compressing nerve roots Medical management (based on cause) Bowel and bladder care

11. Prognosis After surgery, Improvement in pain and weakness Return of bowel and bladder function in, 88.9% if treated within 24 hrs 79% if treated within 24-48 hrs and 44% if >48 hrs.

12. Thank You