Cauda Equine Injury

The cauda equine is a bundle of nerves at the base of the spine. If the cauda equine suffer an injury, the nerves will not function properly, resulting in neurological symptoms.

If the cauda equine injury is not dealt with quickly enough, these neurological symptoms could be permanent.

How are the cauda equine nerves injured?

The cauda equine can be injured in a number of ways. One of the most frequent causes is a slipped disc.

A slipped disc is when the inner part of a vertebral disc pokes through a weakness in the outer wall. This can press upon the surrounding structures. If a slipped disc occurs in the lower back (in the L4/L5/S1 region) the protruding material can press upon the nerves.

A slipped disc is not the only way in which the cauda equine can become injured. Other causes include:

• Spinal tumours or other lesions such an abscesses
• Inflammatory conditions such as ankylosing spondylitis
• Spinal stenosis or other conditions that cause the narrowing of the spinal canal
• Infection
• Traumatic accidents such as road traffic accidents
• Surgery or other medical procedures such as an epidural
• Spinal haematoma

What does a cauda equine injury do?

The cauda equine nerves are very delicate, so any sort of compression will quickly cause them to suffer an injury. Whenever nerves are injured, it will mean that they do not function properly.

Different nerves in the body enable different functions. The cauda equine nerves provide feeling and movement in the legs, saddle area (buttocks, perineum and genitals) and the pelvic organs (bladder, bowel and rectum).

When the nerves are injured, function in these areas will be reduced or lost altogether. This will lead to very obvious symptoms for the patient who will notice the onset of problems such as:

• Bladder dysfunction, with poor flow, reduced urethral sensation, retention of urine, need to strain and incontinence
• Saddle anaesthesia, with numbness in the buttocks, perineum, genitals and upper leg
• Weakness and poor reflexes in the lower limbs, which can also include foot drop
• Bowel dysfunction, with incontinence and/or constipation
• Pain in the back which may also extend into the legs

How should a cauda equine injury be treated?

A cauda equine injury must be treated with surgery. The aim of the operation is to decompress the nerves, removing whatever is pressing upon the cauda equine. The operation must be carried out immediately, or the nerves will suffer so much damage that the nerves will not be able to heal.

If clinicians do not treat a cauda equine injury in time because of medical errors, there will be a case of medical negligence.

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