Cauda Equina Syndrome

Cauda Equina syndrome is a condition caused by a group of nerve roots (Cauda Equina) located in the lower part of the spinal cord. The nerve root acts as a link between the brain and lower body organs, sending and receiving sensory and motor signals to and from the legs, feet, and pelvic organs. When the nerve root is depressed, the signal breaks off and affects the function of several parts of the body.

Cauda equina syndrome is a rare disease. If people with horsetail syndrome are not treated immediately, this condition can cause permanent paralysis, urinary incontinence and feces, and sexual dysfunction. Sometimes, emergency treatment still fails to restore the patient's overall bodily functions.
Causes of Cauda Equina syndrome

Cauda equina syndrome is caused by a variety of conditions that cause inflammation or pinched nerves in the lower spine. One of the main causes of Cauda Equina syndrome is disc herniation, or the hernia pulp nucleus. A herniated disk is a condition characterized by spinal cavity displacement. In addition, several conditions can also cause ponytail syndrome, namely:

• Infection or inflammation of the spine
• Spinal stenosis
• Lower spinal cord injury
• Birth defects
• Venous artery malformations
• Spinal tumor
• Vertebral hemorrhage (subarachnoid, subdural, epidural)
• Postoperative spinal complications.

In addition, several factors increase the risk of developing cauda equina syndrome, namely:

• Parents
• athlete
• Overweight or obese
• Frequently or often pushes heavy objects
• Back injury due to a fall or accident.

Symptoms of Cauda Equina syndrome

Symptoms of cauda equina syndrome vary, develop gradually and sometimes resemble the symptoms of other diseases, making diagnosis difficult. Symptoms that may appear include:

• Severe pain in the lower back
• Pain along the pelvic nerve (sciatica), in one or both legs
• Numbness in the groin
• Stool obstruction and urination
• Reduction or loss of lower limb reflexes
• Weakened leg muscles.

Diagnosis of Cauda Equina syndrome

Doctors may suspect patients with cauda equina syndrome if they have symptoms that are strengthened by physical examination. During a physical examination, the doctor will test the balance, strength, coordination, and reflexes of the patient's legs and feet. The doctor will ask the patient to:

• sit
• position
• Walk with heels and feet
• Lift legs while lying down
• Fold the body forward, back and side.

Imaging tests are also done to confirm the patient's diagnosis. Among others are:

• Myelography, which is a spinal examination procedure using X-rays and contrast agents injected into the tissue around the spine. This examination can show the pressure that occurs in the spinal cord.
• CT scan, to produce a picture of the condition of the spinal cord and surrounding tissue from different angles.
• MRI, to produce detailed images of the spinal cord, nerve roots and the area around the spine.
• Electromyography, to evaluate and record the electrical activity produced by muscles and nerve cells. Electromyographic results can reveal changes in nerve and muscle function.

Treatment of Cauda Equina syndrome
After the doctor confirms that the patient has been diagnosed with cauda equina syndrome, emergency treatment with surgery must be done immediately. This operation aims to relieve the pressure that occurs at the spinal nerve endings. If horse pigtail syndrome is caused by disc herniation, you can do surgery on the spinal area to remove material that is compressing nerves.

Surgery must be done within 24 to 48 hours of the onset of symptoms. This action aims to prevent nerve damage and permanent disability.

Postoperative care will be performed on the patient after surgery. Some treatments are carried out, namely:

• Drug treatment Doctors will provide several types of drugs to control or prevent other conditions that can be felt by patients after surgery. Among others are:
• Corticosteroids, to relieve postoperative inflammation
• Analgesics, such as paracetamol, ibuprofen, oxycodone, for postoperative pain relief
• Antibiotics, if cauda equina syndrome is caused by an infection
• Medications to control the function of the bladder and intestine, such as tolterodine or hyoscyamine.
• Radiation or chemotherapy as a post-operative follow-up treatment if cauda equina syndrome is caused by a tumor in the spine.
• Physiotherapy. If horse pigtail syndrome affects the ability to walk, the doctor will recommend the patient to undergo physiotherapy. Rehabilitation specialists will plan therapy programs that can help patients regain strength to walk.

Surgery does not directly restore overall bodily functions. This condition depends on the level of nerve injury experienced by the patient. Bladder and intestinal function take several years to return to normal.
Prevention of Cauda Equina syndrome

Precautions Cauda equina syndrome is difficult because its appearance is often caused by injury or unexpected trauma. However, ponytail syndrome caused by infection can be triggered by injection drug use. Therefore, the precaution that must be taken is not to use narcotics injections illegally.
Complications of Cauda Equina syndrome

If left untreated, cauda equina syndrome can cause several complications, including:

• Permanent paralysis. Depression nerves can suffer permanent damage if left untreated, resulting in permanent paralysis, especially limbs.
• Urinary incontinence and feces occur when the body loses control of urination (urinary incontinence) or defecation (faecal incontinence). This condition is caused by nerves that do not function normally.
• Sexual dysfunction. Cauda equina syndrome can also cause nerve function disorders in the reproductive organs, especially in men.

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