Epidural compression syndromes

Background

• Includes spinal cord compression, cauda equina syndrome, conus medullaris syndrome
  • Presentation and initial management are similar; difference is level of neuro deficit
  • The cauda equina (Latin for "horse's tail") begins at the 2nd Lumbar space extending down to the beginning of the sacral nerves. It is distal to the tapered end of the spinal cord, or conus medularis.

Etiology

• Epidural abscess
• Malignancy
• Massive mid-line disk herniation
• Spinal canal hemorrhage

Clinical Features

• Back pain with neuro deficits
  • Weakness in lower extremities, paresthesias/sensory deficits, gait difficultly
  • Deficits usually affect both legs but are often asymmetric
  • Bladder and rectal sphincter paralysis usually reflect involvement of S3-S5 nerve roots

• Conus medullaris syndrome
  • Lesions at vertebral level L2
  • early and prominent sphincter dysfunction with flaccid paralysis of the bladder and rectum, impotence, and saddle (S3-S5) anesthesia

• Cauda equina syndrome
  • Low Back Pain
  • Urinary retention with or without overflow incontinence (Sn 90%, Sp 95%)
  • Rectal incontinence
  • Bilateral sciatica
  • Saddle anesthesia
  • Decreased anal sphincter tone (60-80% pts)
  • Difficulty ambulating and/or wew foot-drop
• Symptoms worsened by coughing (increases intraspinal pressure)

Management

• bladder scan/ultrasound for bladder volume
• consider foley for bladder decompression
• Emergent MRI
  • If considering compression due to neoplasm obtain scan of entire spine
• Radiation therapy
  • If due to neoplasm
• consult neurosurg or ortho (institution dependent)

See Also

• Epidural Abscess (Spinal)

Source

• Tintinalli
• Uptodate

References

Orendácová J, Cízková D, Kafka J, et al. Cauda equina syndrome. Prog Neurobiol 2001; 64:613.