Treatment of cauda syndrome | Kaudasyndrom – Do I have paraplegia?

Treatment of cauda syndrome

The cauda syndrome is a neurosurgical emergency that must be immediately treated with surgical therapy. A conservative therapy should not be attempted if symptoms such as paralysis are present. The aim is to remove the compression of this section of the spinal cord as quickly as possible in order to prevent irreversible secondary damage such as incontinence. To achieve this goal, there are many different methods available today, ranging from major open surgery to minimally invasive techniques. Which surgical method is used depends on the underlying cause, but also on the compression pattern and the experience of the surgeon.

Duration of a cauda syndrome

The length of time during which the symptoms of the chewing syndrome persist depends largely on the time of the start of therapy. If cauda syndrome is diagnosed, neurosurgery should be performed within the next 24-48 hours. Any further delay increases the risk of irreversible damage to the spinal nerves, which can be accompanied by permanent paralysis, incontinence and sensitivity disorders. Only in very rare cases can the spinal nerves recover from a prolonged constriction.

Prognosis for a cauda syndrome

A decisive factor in the prognosis of the cauda syndrome is the time between the first appearance of the symptoms and an adequate therapy. However, the basic compression pattern and the associated symptoms also have a major influence on the prognosis of the individual patient. For example, external sphincter weakness or urological symptoms are associated with a poorer prognosis of regaining full function after surgery.

How is cauda syndrome diagnosed?

The diagnosis of a cauda syndrome is a combination of a good clinical-neurological examination and various imaging measures. The clinical examination usually begins with various functional tests, which examine possible paralysis of the leg and buttock muscles. These include, for example, the one-legged stand, the toe stand, as well as lifting the leg against a wind stand.

Next comes the testing of the various reflexes, such as the hamstring reflex. This is followed by the testing of the sensitivity in the leg area. If the presence of a cauda syndrome is already suspected here, the clinical examination is extended to the perineal region, where sensitivity, anal reflex and sphincter strength are tested.

If the suspicion of a cauda syndrome is suspected after this examination, an imaging procedure, usually an MRI, is performed as quickly as possible to show the narrowing of the spinal cord.In most cases, this can be used to confirm the suspected diagnosis. An MRI of the lumbar spine is an indispensable part of the diagnosis of a cauda syndrome. With this imaging technique, even small narrowings of the spinal cord can be shown and their extent determined.

Furthermore, it is often possible to determine the exact cause of the compression. Thus, herniated discs, fractures of the vertebral bodies, tumors or other causes of the cauda syndrome can be clearly distinguished from each other. The anal reflex describes a contraction of the external sphincter muscle, which is triggered by touching the skin on the anus.

Thus, the anal reflex is considered a foreign reflex, since the sensitive and the performing organ are different. The anal reflex is triggered by the spinal cord segment S3-S5. A lack of this reflex thus indicates a spinal cord problem, which is at S3 or higher. Since, by definition, the cauda syndrome affects the spinal cord segments that are deeper than the fifth lumbar vertebra, this clinical picture also causes a failure of the anal reflex.