ETIOLOGI DAN PATOFISIOLOGI

• Cauda equina is a bundle of spinal nerves which begins at the end of

spinal cord, the conus medullaris.

• When mechanical or chemical neural bundle damage occur between L1

to S1 level, multiple lumbosacral symptoms may develop, and we call

this cauda equina syndrome (CES)

• CES is an urgent situation and mostly needs direct decompression

• many clinicians sub-classified the CES as CES suspected or suspicious

(CESS), incomplete CES (CESI), and CES with neuro- genic retention of

urine (CESR).
• CES is most commonly the result of a large central disc herniation or

prolapse at the L4/L5 or L5/S1 level, which accounts for over 45% of cases

• Preexisting spinal disease such as spinal stenosis or thickening of the

ligamentum flavum is a major risk factor for development of CES, as even

small disc protrusions can result in significant compression in these patients

• Trauma

• Vertebral fracture could lead to CES. Vertebral body fracture with canal

encroachment, laminar fracture, disc rupture, hemato- ma can compress

thecal sac and cause CES. Immediate correc- tion is needed

• Spinal tumor

• Primary or metastatic spinal tumor could compress thecal sac and generate

CES. Incidence widely, metastasis are more fre- quent than primary tumor.
• Spondylitis

• Tuberculous spondylitis and pyogenic spondylitis often ac- company epidural

abscess and pathologic fracture. These condi- tions could compress thecal sac

and lead to CES.

• Chemical neuritis

• After epidural block or spinal anesthesia, CES like symptom could occur. This is

not a surgical situation. Conservative managements are recommended