Cauda Equina Syndrome

Cauda equina syndrome is a surgical emergency and a potential cause of medical malpractice if surgery is delayed.

“Cauda equina” means horse’s tail in Latin. The bundle of nerves extending from the lower end of the spinal cord looks something like a horse’s tail, hence the name for this part of the spinal anatomy. These nerves control bowel and bladder function, sexual function, and muscles and feeling in the legs.

Just after back surgery, when a patient develops numbness and weakness down the legs, and/or loss of control over urination and defecation, that can mean that a mass of blood is pressing on the spine in the lower back. This is called an epidural hematoma. It is urgent to evacuate the blood and relieve the pressure to prevent permanent nerve damage and even paralysis of the legs.

There is a special risk of bleeding near the spine in any patient who is on blood-thinning medicine. Even trauma as slight as a needle stick or a lumbar puncture can cause bleeding that can put pressure on the cauda equina nerves.

Patient safety tip for post-surgery patients with numb legs

Numbness and weakness in the legs is NOT normal after surgery once anesthesia has worn off. If the doctors don’t order an immediate CT scan of the spinal area to check for a hematoma, ask if they have considered it.

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