David Ferguson

Aims & Objectives

Spine Anatomy Signs & Symptoms Diagnosis Treatment

Anatomy
Cauda Equina Dura Mater

Sup. Art. Process L3

Filum Terminale Dorsal Root Ganglion Thecal Sac Intervertebral disc S1 nerve root L5 nerve roots Lumbar IV disc Pedicle L5 vertebra Lateral part of sacrum S2 vertebra

30 Yr Old Woman with lower back pain 1. History?

2. Examination? 3. Diagnosis?

Large disc bulge L4/5

Cauda Equina Syndrome

Cauda Equina Diagnosed

Questions

The dural sac ends at which vertebral level?

L1 L2

S1
S2
Correct!

The Coccyx

Questions

In infants, the spinal cord may extend as far as:

L3 L4

S2

Correct!

The Coccyx

Symptoms
Acute (on chronic) back pain Severe pain 10/10 Constant pain Changing neurology Bladder dysfunction is a bad late sign

Causes
Prolapsed disc Tumour Blood clot Infection Vascular Trauma Congenital canal stenosis Developmental (Syrinx/ Chiari)

Cauda Equina (Dura opened)

Red Flag Symptoms

Bilateral sciatica Saddle anaesthesia Sphincter disturbance Urinary retention Bowel & Bladder Incontinence Reduced Anal Tone Bilateral loss of ankle jerk

Treatment
Urgent decompression for acute cauda equina CES treated within 24hrs are much more likely to recover bladder function Remember Spinal TB: abscess needs to be drained.

Spinal TB

48 year old female with microcytic anaemia and low back ache

Diagnosis
Plain MRI T2 weighted shows if there is lack of CSF around cauda equina CT Myelography

Treatment options

Depend on causes
Spinal decompression & stabilisation
Radiotherapy Antibiotics