What types of spine conditions are the most painful?

CAUDA EQUINA SYNDROME

An extension of the brain, the nerve roots send and receive messages to and from the pelvic organs and lower limbs. Cauda equina syndrome (referring to the group of nerves extending from the lower spine and resembling a “horse’s tail”) occurs when these nerve roots are compressed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage.

If patients with cauda equina syndrome do not seek immediate treatment to relieve the pressure, it can result in permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation, and other problems. Even with immediate treatment, some patient may not recover complete function (AAOS, 2015).

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EMERGENCY RESPONSE

Although leg pain is common and usually goes away without surgery, cauda equina syndrome, a rare disorder affecting the bundle of nerve roots (cauda equina) at the lower end of the spinal cord, is a surgical emergency.

Early treatment is required to prevent permanent problems, however, cauda equina syndrome may be difficult to diagnose. Symptoms vary in intensity and may evolve slowly over time.

See your doctor immediately if you have:

  • Bladder and/or bowel dysfunction, causing you to retain urine or be unable to hold it.
  • Severe or progressive problems in the lower extremities, including loss of or altered sensation between the legs, over the buttocks, the inner thighs and back of the legs (saddle area), and feet/heels.

TREATMENT

If you have cauda equina syndrome, you may need urgent surgery to remove the material that is pressing on the nerves. The surgery may prevent pressure on the nerves from reaching the point at which damage is irreversible.

Antiinflammatory agents, such as ibuprofen, and corticosteroids can be effective in people with inflammatory processes, including ankylosing spondylitis.

People with cauda equina syndrome caused by an infection should receive appropriate antibiotic therapy. People with spinal tumors (neoplasms) should be evaluated for chemotherapy and radiation therapy.

Learn about cauda equina syndrome

PREVENTION

Prevention of cauda equina syndrome is focused on early diagnosis by identifying the symptoms described above. While low back pain with leg pain and/or weakness is a common complaint that affects many people, cauda equina syndrome is a rare complication. Doctors should be vigilant in identifying these cases. People should be educated on signs and symptoms that could suggest possible cauda equina syndrome, including change in bowel or bladder function and loss of sensation in the groin.

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