Classification of Cauda Equina Syndrome

Cauda equina syndrome is either classified as incomplete or complete. In this article we look at the two in more detail, explaining why it is so important that treatment is provided while the condition is incomplete.

Incomplete cauda equina syndrome

Incomplete cauda equina syndrome can be abbreviated to CES-I. It is the first stage of cauda equina syndrome, during which the nerves are compressed and function is lost. However, the nerves are not irreparably damaged, and so treatment will still be effective.

When a patient has CES-I, he or she will present with motor and sensory changes. This will include saddle anaesthesia (i.e. numbness between the legs), reduced lower limb reflexes and a history of back pain. Most notably, there will be urinary dysfunction, but will not be incontinent. Instead, the patient will find it necessary to strain during urination, possibly needing to compress the abdomen in order to void. There may also be a loss of sensation and increased frequency.

Complete cauda equina syndrome

Complete cauda equina syndrome can be abbreviated to CES-R. This is the second and final stage of cauda equina syndrome. It happens when the nerves have been subject to prolonged compression. The damage will become increasingly extensive and eventually the root cells will die. When the condition is complete, a patient will not know when their bladder is full due to a total loss of sensation. Consequently the bladder will overflow, leading to an episode of incontinence. This is called overflow incontinence and will be entirely painless.

Once the condition is complete, the nerves cannot be repaired. Although surgery may have some benefits, it will not entail a 100% recovery for the patient. He or she will therefore have permanent neurological problems, which are usually of a life-changing nature. Long-term symptoms include:

• Urinary dysfunction, necessitating the self-catheterisation
• Bowel dysfunction, leading to faecal leakage or incontinence
• Sexual dysfunction, including the inability to achieve an erection/orgasm
• Partial or total paralysis

Delayed treatment of cauda equina syndrome

To avoid these awful consequences, surgical decompression must be carried out while the condition is still incomplete. Although this will not necessarily lead to a total recovery, the outcome will certainly be better than if treatment is provided during the complete stage.

If there is a delay in treatment and a patient progresses to CES-R, questions must be raised as to why this happened. If the delay was caused by a substandard level of medical care, there will be grounds for a compensation claim. Contact us today to find out more.

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