SPINE - NON TRAUMA + TRAUMA
CAUDA EQUINA SYNDROME
PromptCauda equina red flags on History
ResponseBladder or bowel symptoms
Weakness
Sensory changes
Fever
Known Malignancy
Weight Loss
IVDU
Thoracic back pain
Night pain – increased likelihood of malignancy
Steroid use
History of Osteoporosis
Recent invasive procedure to back – eg steroid injection / LP
History of Spinal stenosis
Weakness
Sensory changes
Fever
Known Malignancy
Weight Loss
IVDU
Thoracic back pain
Night pain – increased likelihood of malignancy
Steroid use
History of Osteoporosis
Recent invasive procedure to back – eg steroid injection / LP
History of Spinal stenosis
PromptCauda equina examination findings
ResponseSaddle anasthesia
Lower limb weakness
Palpable bladder/urinary retention
Bilateral LL weakness/parasthesia
decreased/absent LL reflexes
Decreased rectal tone
Decrease/absernt bulbocavernosus/anal wink
Lower limb weakness
Palpable bladder/urinary retention
Bilateral LL weakness/parasthesia
decreased/absent LL reflexes
Decreased rectal tone
Decrease/absernt bulbocavernosus/anal wink
PromptMost common causes
ResponseLarge central disc prolapse / rupture
Malignancy – tumour pressing on cord
Spinal infection
Epidural Haematoma
Trauma
Spinal stenosis
Malignancy – tumour pressing on cord
Spinal infection
Epidural Haematoma
Trauma
Spinal stenosis
PromptImmediate investigations and treatment:
ResponseUrgent MRI
Urgent neurosurgical consultation with view to surgical decompression
Urgent neurosurgical consultation with view to surgical decompression