Cauda equina syndrome (CES), a medical emergency when presenting in a younger population, is also a potentially significant consequence of lumbar spinal stenosis (LSS) in older patients. Recent estimates suggest that up to 60% of adults older than 65 years of age may display MRI evidence of LSS, with or without corresponding symptomatology. It is reasonable therefore, that as the population ages, the prevalence of CES secondary to LSS will also increase. Regardless of onset, the symptoms of LSS present classically as neurogenic claudication, encompassing a range of symptoms such as aching, cramping, tingling and heaviness which are worsened with walking and lessened with sitting. These symptoms are generally attributed to transient ischemia of the lumbosacral/cauda equina nerve roots due to a combination of mechanical compression, nerve root edema and/or venous congestion – resulting from stenosis in the lumbosacral spinal canal.
The most concerning symptoms of cauda equina nerve root compression include urinary and/or fecal incontinence, loss of function of the legs, sexual dysfunction and sensory loss in the saddle and/or lower legs. These symptoms, while commonly screened for in younger patients, are rarely reported in the literature relating to patients suffering from LSS and can present as complications of age-related conditions in the older population, confounding the diagnosis of CES in this cohort. Recognition of these symptoms in an older population remains challenging and can have devastating consequences for the patient if not properly identified.
These authors summarized the evidence to identify the challenges and gaps in the literature regarding CES in older adults with LSS…LOG IN OR SUBSCRIBE TO ACCESS THIS REVIEW!
THIS WEEK'S RESEARCH REVIEW: “Cauda Equina Symptoms in Older Adults with Lumbar Spinal Stenosis”
This paper was published in Musculoskeletal Science and Practice (2020) and this Review is posted in Recent Reviews, Lumbar Spine - Disc/Neurological, Spinal Stenosis and the 2020 Archive.
Spinal stenosis