[Emergency scenario: cauda equina syndrome--assessment and management].
Acute low back pain is one of the most frequent reason for an emergency or primary care physician visit. Up to 90% of all adults will experience an episode of back pain at some point during their lifetime. Although the majority of patients have uncomplicated benign presentation and 80-90% recover within 4 to 6 weeks, there is a small subset who has an underlying potential life-threatening etiology. Among them are aortic dissection, ruptured abdominal aortic aneurysm, vertebral osteomyelitis, spinal epidural abscess and the cauda equina syndrome (CES). The latter entails a compression of the nerve roots of the cauda equina. These patients usually present post-traumatically with the clinical triad of saddle anesthesia, bowel or bladder dysfunction and muscular weakness of the lower extremeties. A delayed diagnosis can result in a significantly increased morbidity. Therefore, early diagnosis and the initiation of the appropriate therapeutic steps are essential. A thourough anamnesis and physical examination are leading to the suspected diagosis. Below, clinical presentation, diagnosis and relevant treatment of the CES are discussed.
Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen. Oliver.Gautschi@kssg.ch
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D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001416:Back Pain / Q000209:etiology*; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D017586:Diskectomy; D004630:Emergencies; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D009460:Neurologic Examination; D011128:Polyradiculopathy / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D012447:Sacrum / Q000601:surgery; D013126:Spinal Nerve Roots / Q000601:surgery
D000305:Adrenal Cortex Hormones