Cauda equina syndrome is the result of damage to peripheral nerve bundle which is called the cauda equina. Cauda equina means the ponytail in Latin.
COLUMNA VERTEBRALIS AND SPINAL CORD
Spine is composed of vertebrae.Each vertebrae has a large anterior part ( corpus ) and a posterior part ( vertebral arch ). The central cavite between corpus and arch is called as a vertebral foramen.
Spine is divided into cervical,thoracic,lumbar,sacral and coccygeal regions. Each cervical,thoracic and lumbar vertebrae is divided from each other with intervertebral disc which allows slight movement of vertebrae.In order , sacral and coccygeal vertebrae come together to create the sacrum and coccyx.If you cut the spinal cord longitudinal , you can see that all vertebral foramina create the vertebral canal.
Spinal cord connects to the brain and from the spinal canal it goes to the second lumbar vertebra, ending in a cone called the conus medullaris.
There are 8 cervical,12 thoracic,5 lumbar,5 sacral and 1 coccygeal spinal nerves.Each nerve lefts from related intervertebral foramina which are openings between two adjacent vertebrae.To achieve related openings of lumbar,sacral and coccygeal regions , should be go forward down from spinal canal and there is an nerve bundle that is called cauda equina just under the spinal cord.
These nerves carry motor innervations for internal,external anal sphincter , leg muscles and genital organs.Leg and pelvis muscles are innervated by these nerves.
THE CAUDA EQUINA SYNDROME
CES is occurred by compression trauma or damage to more than one nerves of cauda equina.The most common reason is the large lumbar disc hernation.It can be congenital i.e. it is caused by spondylolisthesis where the bones are re-ossified by the intervertebral discs and narrowing the lumbar vertebrae, usually due to degenerative disorders such as ankylosing spondylitis, where the person is born or acquired with it.That trauma can result from surgery or degenerative spine disease.The most common lumbar spondylolisthesis type is the anterolisthesis in which a vertebra moves forward and into spinal canal,causing compression of nerves.
- The muscle tone of anal sphincters and mesane decreases.Because of that, control of mesane and bowel decreases.
- Sexual functions decrease
- There is a numbness at glutes
- Unilateral or bilateral muscle weakness
- Loss of knee and ankle reflexes
- Paraplegia which is loss of sensory and muscle control of legs
- Sharp pain down to the leg
DIAGNOSIS AND TREATMENT
The diagnosis of Ces is usually based on the above-mentioned symptoms, sensory and motor nerve findings and diagnosed by MRI or BT scanning.If the reasons are disc hernations,trauma,tumour or abscess , the surgical decompression is performed within 48 hours. Abscess are treated with antibiotics and then surgical treatment is performed. However, if the reason is degenerative diseases, symptoms appear slowly.In this situation , anti-inflammatory and cortico-steroid drugs are given.In addition, some exercises may be given to patients accompanied by a doctor or a physiotherapist after the surgery.
PHYSIOTHERAPY IN THE CES
Exercise is quite benefical to regain ability of strength and balance. Regular physical activity is useful for blood flow to lower extremity .Also doing exercise affects the mood positively and may decrease the depression.
In general , the aerobic exercises like walking,running,swimming and cycling are recommended for CES patients.These kind of exercises are not useful just for strengthening muscles and improving balance , also they are effective for the circulatory system.For the best results, at least 30 minutes and 5 days a week the aerobic exercises are added to physiotherapy program .
The resistance exercises may be helpful for increasing endurance.The CES patients can do these exercises 10-15 reps and 2 or 3 sets at 1-2 times a week.
These resistance training sessions can be spaced throughout the week to give the muscles a sufficient amount of recovery time. Ensuring safety during exercise is crucial for those living with CES. Often, patients will be encouraged to work with a physical therapist who specializes in this area for assistance in starting an exercise program. Patients may need to participate in a physiotherapy program for several weeks before they are considered healthy enough to engage in independent physical activity.
- Cauda equina syndrome is a condition caused by damage or compression to the nerves or the cauda equina. The most common cause is a lumbar disc herniation.
- Typical symptoms include decreased urinary and bowel control, decreased sexual function, and saddle-like numbness in the hips.
- Depending on the cause, it can be treated with surgery, as well as with anti-inflammatory drugs or antibiotics.
- Exercises to strengthen the waist muscles after surgery; strengthening exercises for the pelvic floor muscles and helping to provide bladder control; posture exercises for bad posture caused by the lumbar region after surgery are among the physiotherapy program that will be specially prepared by the physiotherapist with other auxiliary physical therapy agents.
Exercise should become a part of our lives, not only to be protected from Cauda equina syndrome, but also to be protected from all other diseases. We should pay attention to ergonomic conditions in daily life and use appropriate and healthy positions for our musculoskeletal health.We must pay attention to our health. Thus, we reduce the risk of both CES and other musculoskeletal diseases. Below are 5 exercises that can be done for our spine health. It should not be forgotten that the exercises are specially planned by physiotherapists according to the condition of the person and included in the treatment program.