A Simple Guide to Cauda Equina Syndrome, Diagnosis, Treatment and Related Conditions

By Kenneth Kee

This book describes Cauda Equina Syndrome, Diagnosis and Treatment and Related Diseases

Recently I have a patient who had a daughter who develop cauda equine syndrome while visiting the grandmother in another country.

While carrying a heavy pail of water her legs suddenly gave way and she fell to the ground.

She was sent to a hospital in that country where a CAT scan showed a fracture in the lumbar disk in L3-4 and a flattened disk in L4-5.

There was pain followed by loss of muscle strength and weakness of the leg especially the left leg.

There was also numbness of the both legs and the perineal region (where the anus, vulva and urethra were located) resulting in incontinence of bladder and bowel.

She had immediate surgery done to remove the fractured disk in L3-4 and the flattened disk in L4-5.

These disks were replaced by metal micro-disks.

During the next 3 weeks she was having physiotherapy done in the hospital with some improvement to the legs.

However the numbness of the saddle area (where the anus, vulva and urethra were located) did not improved and she continued to have incontinence of the bladder and bowel.

MRI done showed the integrity of the spine with the micro-disks and the nerves were intact and there were no other compression seen.

It was at this time the hospital went into lockdown due to the Covid-19.

My patient bought his daughter back to the grandmother’s house and had a private physiotherapist to help her with her physical exercises.

There was a gradual return of function to the legs with improved movement and sensation.

Unfortunately the sensation in the saddle area did not improve.

The daughter still has incontinence of the bladder and bowels.

After 1 year and 2 months after the illness, she was able to walk for short distances but she still has problems with her bowel and bladder control.

She and her parents were able to return to Singapore by plane.

It is for this reason that my patient has consulted me to refer her to a good neurologist for further review of her condition.

The bundle of nerves at the end of the spinal cord is termed the cauda equina, due to its resemblance to a horse's tail.

These nerves transmit and receive messages to and from the lower limbs and pelvic organs.

The cauda equina continues from the nerve roots in the lumbar region.

The cauda equina communicates with the brain, transmitting nerve signals back and forth regarding the sensory and motor functions of the lower limbs and the organs in the pelvic region.

If these nerve roots become pinched, the patient can develop a disorder termed cauda equina syndrome (CES).

It is a rare disorder evaluated to affect 1 in 33,000 to 100,000 people.

Cauda equina syndrome (CES) happens when the nerve roots of the cauda equina are pinched and interrupt motor and sensory function to the lower extremities and bladder.
Patients with this syndrome are often sent to the hospital as a medical emergency.

CES most often results from a large herniated disc in the lumbar region.

Other possible causes of CES are:
1. Lesions or tumors on the lower spine
2. Spinal stenosis,
3. Inflammation of the lower spine
4. Spinal infection
5. Birth defects

Most common symptoms are
1. Motor or sensory deficits in the legs – normally bilateral but can also be unilateral and asymmetrical
2. Lower motor neuron signs in the legs – areflexia, hypotonia, atrophy
3. Saddle anesthesia
4. Absent or decreased rectal tone

The gold standard method of evaluation for CES is getting urgent MRI imaging.

Urgent surgery is normally the treatment of choice.

If untreated CES can result in permanent paralysis and incontinence.

TABLE OF CONTENT
Introduction
Chapter 1 Cauda Equina Syndrome
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnos

• Language: English
• Publisher: Kenneth Kee
• Release date: Apr 13, 2021
• ISBN: 9781005711962

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

A

Simple

Guide

To

Cauda Equina Syndrome,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2021 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Cauda Equina Syndrome, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Cauda Equina Syndrome)

This e-Book is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiography account of my journey as a medical student to family doctor on my other blog: http://afamilydoctorstale.blogspot.com.

This autobiography account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

My diagnosis and treatment capability has improved tremendously from my continued education.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Cauda Equina Syndrome

Recently I have a patient who had a daughter who develop cauda equine syndrome while visiting the grandmother in another country.

While carrying a heavy pail of water her legs suddenly gave way and she fell to the ground.

She was sent to a hospital in that country where a CAT scan showed a fracture in the lumbar disk in L3-4 and a flattened disk in L4-5.

There was pain followed by loss of muscle strength and weakness of the leg especially the left leg.

There was also numbness of the both legs and the perineal region (where the anus, vulva and urethra were located) resulting in incontinence of bladder and bowel.

She had immediate surgery done to remove the fractured disk in L3-4 and the flattened disk in L4-5.

These disks were replaced by metal micro-disks.

During the next 3 weeks she was having physiotherapy done in the hospital with some improvement to the legs.

However the numbness of the saddle area (where the anus, vulva and urethra were located) did not improved and she continued to have incontinence of the bladder and bowel.

MRI done showed the integrity of the spine with the micro-disks and the nerves were intact and there were no other compression seen.

It was at this time the hospital went into lockdown due to the Covid-19.

My patient bought his daughter back to the grandmother’s house and had a private physiotherapist to help her with her physical exercises.

There was a gradual return of function to the legs with improved movement and sensation.

Unfortunately the sensation in the saddle area did not improve.

The daughter still has incontinence of the bladder and bowels.

After 1 year and 2 months after the illness, she was able to walk for short distances but she still has problems with her bowel and bladder control.

She and her parents were able to return to Singapore by plane.

It is for this reason that my patient has consulted me to refer her to a good neurologist for further review of her condition.

What is Cauda Equina Syndrome?

The bundle of nerves at the end of the spinal cord is termed the cauda equina, due to its resemblance to a horse's tail.

These nerves transmit and receive messages to and from the lower limbs and pelvic organs.

The cauda equina continues from the nerve roots in the lumbar region.

The cauda equina communicates with the brain, transmitting nerve signals back and forth regarding the sensory and motor functions of the lower limbs and the organs in the pelvic region.

If these nerve roots become pinched, the patient can develop a disorder termed cauda equina syndrome (CES).

It is a rare disorder evaluated to affect 1 in 33,000 to 100,000 people.

Cauda equina syndrome (CES) happens when the nerve roots of the cauda equina are pinched and interrupt motor and sensory function to the lower extremities and bladder.

Patients with this syndrome are often sent to the hospital as a medical emergency.

Cauda equina syndrome can induce incontinence and even permanent paralysis.

Incidence

Cauda equina syndrome is not linked to gender or race.

It happens mainly in