Kauda syndrome (also called cauda syndrome) refers to a bruising of the nerves in the cauda equina region. It is often accompanied by a severe disc herniation and requires immediate action when typical symptoms occur to decompress the bruised nerves and avert worse consequences such as paralysis.
What is cauda syndrome?
Kauda syndrome refers to the symptoms and medical conditions associated with a crush of the sensitive nerves in the lower part of the spinal cord, called the cauda equina. The symptoms include pain in the lumbar spine that radiates down one leg or even both legs into the lower legs, and severe bladder pain that is exacerbated by an increase in body pressure (for example, when sneezing or coughing). Kauda syndrome is characterized by the so-called breeches anesthesia, which means that the anal area and the area of the inner thighs become numb. Impotence is another symptom of Kauda syndrome. Control of bowel and bladder emptying is often lost, and rectal examination reveals a flaccid sphincter. The legs become weak, proper foot jack weakness is noted in many cases, and the mechanical reflexes of the leg (for example, hamstring reflex) no longer function properly or at all.
Causes
Kauda syndrome is always triggered by damage to the sensitive nerves in the lower spine caused by a (usually prolonged) contusion. The bruising of the nerves leading to Kauda syndrome can in turn be caused by various triggers. On the one hand, it can be a particularly severe herniated disc, on the other hand, metastases in the area of the lower spine can be responsible for the damage pattern. A bone injury, a pushing out of individual vertebrae, which then press on the nerve fiber complex, or a vertebral fracture are also possible causes. Tragically, however, the typical crushing of the nerve fibers that then cause Kauda syndrome also occurs in some cases during surgical procedures.
Symptoms, complaints, and signs
As it progresses, Kauda syndrome is manifested by a series of symptoms and complaints that appear suddenly and lead to chronic disorders within a short period of time. Most people initially experience nonspecific back pain or sensory disturbances in the lower back. Often, paralysis symptoms of the arms and legs are added. If the contusion is not treated promptly, permanent paralysis may result. The pinching of the nerves can also cause loss of bladder and bowel control. Patients usually also develop a chronic pain syndrome that significantly limits their quality of life. Kauda syndrome usually presents acutely. It is often preceded by a severe herniated disc, a bone injury or metastases. Externally, the syndrome is not recognizable. However, as the disease progresses, it can lead to poor posture, limited range of motion and other symptoms that are visible externally. If Kauda syndrome occurs during an operation, the symptoms appear quite suddenly and rapidly increase in intensity. If not treated or treated too late, the nerves are permanently damaged. This can lead to incontinence, circulatory problems and, in the worst case, paraplegia, among other symptoms.
Diagnosis and course
Kauda syndrome is one of the most dangerous medical conditions that can occur in humans and must be treated immediately. Indeed, if surgical decompression of the crushed nerve fibers is not performed within the first six hours after the onset of the typical symptoms, the symptoms (i.e., for example, paralysis and sensory disturbances of the legs and loss of control over the bladder and bowel) usually become chronic and may only partially regress in rare exceptional cases. Therefore, the diagnosis of Kauda syndrome plays a central role. As soon as signs of Kauda syndrome appear, the diagnosis must be made immediately. Neurological examinations (for example, checking the Achilles tendon or patellar tendon reflex, testing tenderness in the affected regions and the sphincter muscle) in conjunction with imaging procedures such as computer tomographies or MRIs can be used for the diagnosis.Once diagnosed, Kauda syndrome must be treated immediately.
Complications
In most cases, Kauda syndrome occurs in conjunction with a herniated disc. This results in significant limitations in the patient’s movement and daily life. If treatment is not sought promptly, the nerves may be irreversibly damaged, resulting in significant limitations in the patient’s life. The pinching of nerves usually results in paralysis or various disturbances of sensitivity. Those affected suffer from considerable back pain and severe paralysis in the legs. It is therefore not uncommon for patients to be dependent on a wheelchair and also on the help of other people in their daily lives. At the same time, the paralyses can also lead to considerable psychological discomfort or depression. It is not uncommon for those affected to also struggle with suicidal thoughts. The quality of life is significantly reduced by Kauda syndrome. As a rule, treatment must be administered within a few hours of the first onset of Kauda syndrome. It may not be possible to save nerves in the process. If treatment is delayed, irreversible damage usually results, leaving patients with limitations for the rest of their lives. However, life expectancy is not reduced by Kauda syndrome.
When should you see a doctor?
Sudden pain in the lower back is considered a warning sign of the organism. They should be examined and treated immediately so that there is no increase in discomfort and no lifelong impairments develop. Abnormalities of the lumbar spine are considered worrisome and should be clarified by a specialist. If the pain extends into the anal region of the affected person, a visit to the doctor is required immediately. In the case of paralysis, restrictions of the usual mobility or loss of the usual physical performance level, a doctor is needed for further examinations and the search for the cause of the complaints. The affected person should take it easy immediately after the onset of pain and perform only slow movements until medical attention is sought. Disturbances in sensitivity, numbness or hypersensitivity to touching the lower back should be investigated and treated. If a contusion of the back occurred due to an accident, fall or physical assault, a visit to the doctor is required. Imaging procedures will be used to assess the damaged region so that the necessary steps can be taken to provide medical care. If men additionally experience a disturbance of potency, this symptom is alarming. A doctor must be consulted as soon as possible. If discomfort sets in when emptying the bowel or kidney, a visit to the doctor is also necessary.
Treatment and therapy
If Kauda syndrome has been diagnosed, neurosurgical intervention is indicated as soon as possible to decompress the nerve fibers affected by the contusion. This surgery should be performed within the first six hours of the onset of one or more symptoms of Kauda syndrome to prevent permanent damage to the nerves. If the intervention comes too late and the contusion has already irreparably damaged the nerves, the symptoms of Kauda syndrome do not regress but remain chronic. Affected patients then suffer from paralysis and numbness and usually lose control of the bladder and bowel. Only in very few cases can stimulation of the damaged nerves result in regaining partial control over the affected areas of the body.
Outlook and prognosis
The prognosis of Kauda syndrome depends on the triggering disorder. If the bruising of the nerves can be relieved by correcting the vertebrae with some professional manipulations, there is usually relief within a short time. In the case of a fracture, contusion or compression of the bones, there is also a good chance of recovery. It takes some time of rest and sparing, as well as monitoring of the regeneration process, until improvement is seen. The course of the disease and the prognosis worsen if metastases have formed in the organism. If these are responsible as the causal reason for the complaints, cancer therapy must be carried out.The prospect of a cure depends on the stage of the cancer. In severe cases and in the event of advanced development, the patient is threatened with premature death. In the case of a particularly severe herniated disc, the prognosis is also worse. An improvement in health can be achieved through surgical intervention. Surgery is associated with various risks and side effects. In addition, various complications can occur in the further course of healing, which have an impact on the prognosis of Kauda syndrome. There is a possibility of a chronic course of the disease. This leads to a considerable restriction of the quality of life as well as the management of everyday life and can trigger psychological sequelae.
Prevention
There is currently no known effective prevention of Kauda syndrome. However, it is certainly useful to be active in sports, not to put too much weight on the scale, and to have strong trunk muscles in order to minimize the likelihood of suffering a herniated disc. However, it remains central to seek immediate medical attention at the first onset of symptoms of Kauda syndrome – and thus at least prevent the symptoms of Kauda syndrome from becoming chronic.
Follow-up
In most cases, the measures of follow-up care for Kauda syndrome are very limited. Here, first and foremost, the affected person should see a doctor at a very early stage so that no further complications or even further complaints occur. Only early detection of the disease can prevent further worsening of the symptoms. Ideally, affected persons should have already consulted a doctor at the first signs of Kauda syndrome. Self-cure cannot occur with this disease. This disease usually requires immediate surgical intervention to prevent permanent paralysis in the affected person. After such an operation, strenuous, stressful or physical activities should be avoided at all costs. Many patients are also dependent on the help and support of their own family in their daily lives, whereby intensive and loving conversations can also have a positive effect on the further course and also on the condition of the affected person. Likewise, measures of a physiotherapy are necessary, whereby many of the exercises from such a therapy can also be repeated in the own home. In most cases, Kauda syndrome does not limit the life expectancy of the affected person.
What you can do yourself
Immediate action is required when Kauda syndrome occurs. The affected person should consult a doctor at the first symptoms and have the symptoms clarified. If the contusion is treated early enough, the spine may be loaded again relatively quickly after the procedure. However, rest is recommended for the first two to three weeks. Physical work, especially work that could strain the intervertebral discs, should be strictly avoided. Accompanying follow-up care, the causes of the contusion must be determined. Often a tumor is causative, which must be diagnosed and treated. If the Kauda syndrome is based on chronic poor posture, therapeutic measures are indicated. In most cases, occupational stress must also be reduced. If treatment of the contusion is too late, permanent nerve damage has usually already occurred. The resulting paralysis must be treated with physiotherapy. The most important self-help measure is to reduce the daily restrictions by means of aids and a handicapped-accessible facility. Therapeutic counseling helps the affected person to accept the new life situation. In addition, it makes sense to visit a self-help group, because talking to other affected people makes it much easier to deal with a disability.
