Cauda equina syndrome
Introduction
A simultaneous compression of several, eventually all lumbosacral spinal nerve roots may lead to the development of a complex clinical entity called cauda equina syndrome (CES) (Aho et al., 1969, Jaradeh, 1993). Clinical signs accompanying CES may differ in each individual patient but the fully developed syndrome is characterized by low-back pain, bilateral sciatica, saddle hypaesthesia or anaesthesia, motor weakness of the lower extremities, impairment of anal, bulbocavernous, medioplantar, and Achilles’ tendon reflexes bilaterally, rectal and bladder sphincter's dysfunction as well as sexual impotence (Aho et al., 1969, Floman et al., 1980, Rhein et al., 1985, Kostuik et al., 1986, Humphrey, 1990, Byrne, 1993, Jaradeh, 1993, Shapiro, 1993, Leroi et al., 1994, Drábek, 1995). The clinical picture resembles that observed after an injury of conus medullaris, however, with the exception that symptoms may be asymmetric (Aho et al., 1969, Jaradeh, 1993).
Section snippets
Ontogeny of the spinal cord and cauda equina
The pairs of the dorsal (sensory) and ventral (motor) roots occurring caudally to the level of termination of the spinal cord form the cauda equina that is located in the dural sac filled with cerebrospinal fluid in the subarachnoid space. Laterally, the pairs of nerve roots, including the dorsal root ganglia, pass out from the spinal canal through the nerve root canal (Rydevik et al., 1984, Cohen et al., 1989, Rydevik, 1993).
The development of the cauda equina begins in the human embryo soon
Symptomatology
Polyradicular symptomatology of the CES results from a dysfunction of sensory, motor and autonomic components of the lumbosacral nerve roots and is often diagnosed as low-back pain, saddle anaesthesia, bilateral sciatica, motor weakness of the lower extremities or chronic paraplegia and bladder dysfunction (Byrne, 1993). In order to identify the signs resulting after different nerve root involvement, four distinct forms of the cauda equina compression can be described; upper (L2-L4 nerve
Herniated lumbosacral discs
Partial or total paralysis in both legs, with impaired sensitivity, urodynamics and micturition and sphincter dysfunction may develop acutely or subacutely, when the cauda equina is compressed by a massive protrusion of a disc or a sequestration. An extreme variability of the symptoms and signs, their development, course, nature and severity occurring in the cauda syndrome is caused by various factors such as localization, size and extent of the disc disorder. Six different types can be
Dog models of the cauda equina compression
Several animal models mimicking the cauda equina syndrome have been used to study and explain the pathophysiology of the polyradicular symptomatology of the syndrome. Among them porcine and canine models clearly predominate.
A model of lumbar spinal stenosis in dogs was developed consisting of the entire cauda equina constriction at the seventh lumbar level with a nylon electrical-cable tie, 2.8 mm wide, placed circumferentially around the dura (Delamarter et al., 1990) and, after a laminectomy
The diagnosis of the cauda equina syndrome
The correct diagnosis of the cauda equina syndrome accompanied by back pain, sciatica and bladder dysfunction is usually based on detailed history and clinical picture (Kerr et al., 1988; Jaradeh, 1993) and supported by basic blood tests, chemistry with fasting glycemia, sedimentation rate, syphilis, and lyme serologies. There are multiple imaging modalities available for localizing and evaluating the causes of the cauda equina compression. However, there is no single imaging modality which
Acknowledgements
The authors thank to D. Krokavec, M. Syneková, M. Špontáková, M. Tkačiová, M. Vargová and I. Vrábelová for their excellent technical assistance. The experimental work was supported by the VEGA Grant No. 2/7222/20 from the SAS and by NIH grant NS 32794 to M.M.
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