What Is Cauda Equina Syndrome?
By Vickie Wolfe
A cauda equina
syndrome is what you get when you impair the function of many or all of the nerve
roots in the cauda equina area. Since these nerve roots serve sphincter and sexual
function, sensation around the perineum (anus, genitalia) sensation in the legs,
muscles throughout the legs, etc., it is possible to get pain and numbness as well
as bladder and bowel dysfunction, sexual dysfunction and muscle weakness
in the legs. Simply put, CES is damage to these nerve roots.
anatomists who dissected cadavers thought that this area, with itís collection of
nerve roots, looked like the tail of a horse, thus the Latin name, Cauda Equina.
Looking at the picture below you can see why it looked like the tail of the
horse to them.
Below is an illustration* of the cauda equina area. You can see the disc
herniation at L5- S1 compressing the nerves in the cauda equina area.
There are many of us that ended up with CES from a centrally herniated disc, usually at L4/5 S1. In too many cases, for one reason or another, our doctors didnít act soon enough and by the time we did have surgery to relieve the compression it was too late and we are left with what may be permanent nerve damage. The time before surgery, when it may still be possible to relieve this compression and avoid permanent nerve damage is the acute stage of cauda equina syndrome. Once we have the surgery and are left with the nerve damage we are in the chronic stage of cauda equina syndrome. Our hope is to reach patients and doctors and teach them to recognize the acute stage, act quickly to relieve the compression and avoid the chronic stage of Cauda Equina Syndrome.
How CES is Accquired?
Before I explain HOW a disc ruptures I will quickly explain the areas of the
spinal column. The spinal column is made up of 33 vertebrae separated by 23
intervertebral discs. The spinal column had 3 distinct areas, the cervical,
thoracic and lumbar areas. There are also five sacral vertebrae and coccyx.
The lumbar area is where the cauda equina nerves are located.
Each vertebrae is separated by an intervertebral disc. These discs are sometimes
called the "shock absorbers" of the spine. They cushion and stabilize the
The nucleus pulposus is the inner core of the disc which consists of a gelatinous
material. The annulus fibrosis is the outer layer of the disc which is the strongest
portion of the disc and provides strength to prevent disc herniations. People
sometimes say they have a "slipped disc" in their back. In reality, a disc can't
slip out of place. But discs can be injured. Sometimes the outer layer, the annulus
fibrosis can tear and this allows the inner pulposus (the jelly like substance)
to leak out. What causes the disc to rupture? Well it could be any type of
accident perhaps simple wear and tear or the effects of aging.
Discs rupture all the time and we usually don't even know it. The rupture can be
very small, a tiny tear with only a small amount of pulposus coming out. Usually
when a disc ruptures, the inside pulpous goes to either the right or the left
side of the spinal canal. Look at this illustration*:
This illustration shows the various stages of a disc rupture. Note the cauda
equina area, where our nerves are.
The top two illustrations show first a normal disc, next to that the start of a
bulging disc and the next illustration the disc on the bottom left shows a
ruptured disc where the pulposus goes to the side. This is normally how discs
rupture. There can be some nerve damage, but not the devastating damage that we
get with CES.
Finally look at the illustration on the bottom right side. You can see where the
red is the herniated disc and all that pulposus is going INTO the spinal column
where all our cauda equina nerves are. This is crushing our nerves and cutting off
the oxygen and blood supply. So it stands to reason that the longer we go with
these nerves being crushed the more damage we are going to have.
For most of us, when you read our stories the one thing we all have in common is
that we had a HUGE, CENTRALLY herniated disc. Remember I said some ruptures can
be small, only a small amount of pulposus comes out. With us the rupture is very
large and the amount of pulposus is large. All that goo, that pulpous, goes into
the spinal canal, where our nerves are and crushes our nerves. In my case when my
neurosurgeon saw the MRI films, the area where the disc was herniated was so large
that there was no light coming through on the film. These nerves were totally
crushed. Most of us, that have CES this way, were exactly the same. Is it any
wonder that the longer we went with our nerves being crushed like this, the worse
our damage was? Even patients that were treated relatively quickly have some
nerve damage, but nothing compared to us, the ones who couldn't get our doctors
to listen to us, until it was too late and the damage had been done.
This is basically how we end up with CES from a centrally herniated disc. We have
a ruptured disc, but it is a centrally herniated disc, the tear is large with
much pulposus and it (meaning the jelly like goo) goes into the spinal canal,
where our cauda equina nerves are, and crushes those nerves.
When this happens, when we have a centrally herniated disc we MUST have surgery as soon as possible to relieve the compression. Our nerves in the cauda equina area are being crushed. How much permanent damage we have will depend on how long our nerves are crushed.
Red Flag Signs of CES
If we have the above symptoms we need, immediately, an MRI or a Myelogram with
CT scan. Since a myelogram is an invasive procedure I would always opt for
the MRI. If it shows that we do have a centrally herniated disc we need to have
surgery immediately. Remember, the longer the nerves are crushed the more likely
we will be to have permanent nerve damage.
WILL OUR NERVES REGENERATE?
Nerve regeneration will depend on how long those nerves were crushed and how
much damage has been done. The only way to know is to wait. Doctors tell us that
if the nerves are going to regenerate it can take as long as two years.
When a nerve
is crushed there are three possible outcomes. The nerve may be "asleep" when
there is enough pressure to cause it to completely shut down. It will come back
if the pressure is removed soon enough.
The second possibility is when there is a little more pressure and the nerve
branch, called an axon, is destroyed, but the insulation, called the
myelin is still intact. The nerve can re-grow it's axon if the myelin sheath is
still there to give it a guide back to where it is supposed to go. The rate of
growth under the best conditions is 1mm per day. That is about one inch per month.
The third condition occurs when the axon is crushed and the myelin sheath is disrupted. The nerve will try to grow it's axon, but doesn't have a guide to find it's way back to where it belongs. In this case nerve regeneration is not possible, at least not at this time.
thanks to The Doe Report (www.doereport.com)
for allowing CESSG to use the above illustrations.