Cauda Equina Syndrome: A Surgical Emergency

Cauda Equina occurs when the nerve roots in the lumbar spine are compressed, cutting off sensation and movement. The nerve roots that control the function of the bladder and bowel are especial vulnerable to damage. Cauda equina syndrome is one of the only surgical emergencies in the spine and should be taken very seriously. Watch this video to learn more about cauda equina syndrome, what it is, what are the symptoms, and what to do if you have them.
#thespineguy #caudaequinasyndrome #caudaequina #drbriansu #briansuMD #discherniation #spinetrauma #bladderdisfunction
Dr. Brian W. Su, MD
Spine Surgeon
Chief Development and Strategy Officer | California Orthopedics and Spine
Medical Director of Spine Surgery | Marin General Hospital
Director | Marin Healthcare District Board
Chairman | Marin Specialty Surgery Center
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Contact two locations:
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415-927-5300
2 Bon Air Road, Suite 120
Larkspur, CA 94939
7100 Redwood Blvd, Suite 200
Novato, CA 94945
FTC: This video is not sponsored.
Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Information obtained from this video should not be taken in lieu of your own medical provider's advice and treatment plan. Please consult directly with a physician or other healthcare professional regarding any diagnosis or treatment plan options. Content provided on this KZbin channel is for informational purposes only and should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose , treat, cure or prevent disease.

[@franceswilliams209]

I have CES, had 2 laminectomies. Still can't get my head around it but this explanation helps so have forwarded to my family who think I'm just exaggerating things for attention. Thanks so much x

[@davidkays-cx3rj]

Keep fighting Your pain is real

[@JohnJones-ff4nu]

There is an interesting book call Back in Control. It’s very revealing about back surgery in general.

[@threeshocks5769]

CES ended my career. Even though the surgery was some what success. I'm limited in My daily activity and will be the rest of life.

[@hnuvibhu2696]

​@@threeshocks5769bro what were your early symptoms and duration of symptoms and surgery?

[@hnuvibhu2696]

I'm suffering with disk herniation my symptoms are leg pain back pain Having numbness in penis but having my erection.....total control in urine and stool but no sensation in urine Mri - cauda equina normal Ultrasound - bladder functioning normal size and shape The only major thing is numbness in penis I'm 21

[@dkcorderoyximenez3382]

Very interesting Dr. Su...thank you for your presentation...

[@robertacolarette1594]

I never knew any of this. Thank you so much Dr. Su.

[@carolinelvsewe]

Do you ever speak on the thoracic part of the spine? I have severe pain in this area. I have done physical therapy and cannot get relief. What could it be possibly? 😊

[@DrBrianSuTheSpineGuy]

Yes I can do a video on that.

[@Hibernia2324]

Same here! PT told me in 1994 my back is rigid right over T spine. Tried all kinds of PT over the years and still do mid back mobility exercises, but I still get pain and feels like I'm wearing a tight bra even when I'm not. Have a chronic T4 fracture but doubt that's the culprit at this point.

[@damonmelendez856]

Same here- please do a video on thoracic issues!

[@noplanetb2293]

THANK YOU Dr. Su, your explanation here as with other descriptions and explanations is so clear and effective.

[@Chiroman527]

Thank You Dr. Su - very informative ! I have numerous spinal issues : Spondyliosis, facet joint syndrome, DDD throughout, L2 & L3 Disc bulges into the front and into the back, L5-S1 Spondyloethesis, Multiple sites of Mild to Moderate Stenosis, Cervical Instabilities affecting C2-T2 , military neck, and dextroscoliosis of 25 degrees. I have a leg length discrepancy - right leg is 1.1 inches shorter than the left since 1966 after sustaining a fractured femur at age 15 playing HS Football. I;m 72 now, and suffer with the chronic pains & terrible stiffness from the aforementioned conditions. I also get On & Off "saddle anethesia" , I have bladder / bowel incontinence, which seems to be generated by the Cervical Instabilities. In 2019, after experiencing what I thought was CE, my Neurologist's exam ruled out, and a spine surgeon's review of a new Lumbar MRI at that time, also ruled out CE. However, lately, I am unable to sustain an erection and have poor ejaculation as well. I have had regular Urologist exams, monitoring me for BPH, and he admininisters regular Sonograms of the Bladder - I have been diagnosed with an Overactive Bladder. However, I have not been able to have him pinpoint that cause as being Cervicogenic issue. I have also recently had a Anaorectal manometry, revealing muscle weakness to expunge fecal matter, yet strong holding sprincture abilities - although I will have urine leakage, dribbling, and incontinence. FTR, the LLD in 1966, was left unaddressed by the orto surgeon at the time. After the Body cast came off (3 months), the right leg was obviously shorter. Nothong was done - adjusted shoes, etc... Until 30 years later, but the damage was done to my hips and spine by then. Furthermoe, during 2018, & 2019, I visited 6 different Neruo & Spinal Surgeons for opinions for surgery. Doctors at Mt. Sinai, Columbia Pres., White Plains, hospital all opined that There is No Surgery for me....Too much Arthritis they said. Only Pain management. Your Opinion is appreciated.

[@DrBrianSuTheSpineGuy]

You can call 415-925-8200 for a second opinion

[@amigatommy7]

I don't do Ortho surgeons since the last one messed up 3 disks. The Neuros do not like to go in if you are not dying but they can fix bad Ortho mistakes.

[@mvp2503]

Good informative video...I actually have a l5-s1 herniated disc extrusion type where it ropture out of the outer walls, I feel fine now after a few months of sciatica pain, I went to a pain management doctor and he gave me epidural steroid injections. but the surgeon still recommends surgery. I don't want to do surgery after all I feel real good now about 80 percent of my old self and I am no longer in pain..Your opinion is appreciated Dr. Brian if you can give me your feed back or if I can get a second opinion...

[@junbug1029]

Thank you. I’ve said I most likely won’t have surgery except for the onset of cauda equina syndrome but I’ll be 70 this years and it’s good to know my risk is less than I thought.

[@mahmoudabualfa3347]

u got the surgery or not?

[@junbug1029]

@@mahmoudabualfa3347 no.

[@hnuvibhu2696]

I'm suffering with disk herniation my symptoms are leg pain back pain Having numbness in penis but having my erection.....total control in urine and stool but no sensation in urine Mri - cauda equina normal Ultrasound - bladder functioning normal size and shape The only major thing is numbness in penis I'm 21

[@neelamr30]

Suffering also l4l5s1 what u do any medicines

[@hnuvibhu2696]

@@neelamr30 asteroid chalu hai

[@neelamr30]

@@hnuvibhu2696 mere b ...and apka reports me kya hai L5 S1 hai kya

[@neelamr30]

@@hnuvibhu2696 muje to doctor surgery boli hai kya kru kuch samjh nhi aarha

[@Sloff1155]

I actually believe that I might have this, and I have been struggling with my insurance, which is Medicaid for nearly 10 years now, trying desperately to get an MRI. And my condition is only worsening. And now, as of 20 24 I no longer have health insurance So I'm at serious risk of this progressing and getting much worse. In fact, it might end up paralyzing me. What are my options? I can't seem to qualify for any kind of health care out here in Louisiana.

[@bettyboo1519]

Interesting Thank you Dr Brian. Having had lots problems with Spine, my late op of acdf,but suffering 6 months on, I'm wondering if I will ever have some relief 😔 I'm having bladder/bowel problems. I have hiatus hernia, which my Dr says, will not be dealt with. I'm in agony.

[@davidkays-cx3rj]

Your videos are so amazing Use of electronic devices has ruined us We of the forward head nod generations Your instruction is amazing You should be at Stanford !!!

[@shellykeyes8389]

Wow thanks for the great explanation…I’m dealing with a laundry list of back issues & don’t have insurance. Buzzwords are my friends!

[@HighTen_Melanie]

Wow you speak so fast! Really interesting. I’ve have x4 spinal surgeries over the past 25 years. I’ve been wheelchair bound for 22 years with CES . Only 3rd surgery was a spinal emergency I was 46 and it was a central disc prolapse.

[@Hibernia2324]

Thank you for your excellent explanation. Do nerves at all levels move out of the way with movement? I get cervical radiculopathy symptons when looking down, even for a few minutes. The first surgeon I consulted with said position doesn't matter bc the nerves move with position. 2nd opinion MD said he never heard of that happening. Very frustrating.

[@DrBrianSuTheSpineGuy]

Cervical spine has a spinal cord that's a totally separate problem. Please watch the videos on cervical radiculopathy

[@Sklipchan]

Thank you Dr. Su for another clear and excellently explained video!

[@leonaowen9234]

OMG finally a US doctor talks about Cauda Equine-there are many videos from Europe England about CES. I am so concerned I could have CES. I have back pain and dealing with fecal incontinence since 2019 pain is getting so much worse now strange sensation at anal area which causes me to not want to eat. Now also through out the day aching pain across the sacrum area switching to stabbing pain to left butt cheek switching to pain shooting down inner left thigh to knee switching to sharp pain in groin area. I'm 70 female have complain to doctor for several years as pain keeps getting worse. With his guessing attempts I have had colonoscopy, 3 internal hemorrids removed, been to physical therapy (no help) shot in SI joint (no help) pelvic doctor says my coccyx bone bent all the way up. Pushed pushed for MRI- MANY things such as multilevel degenerative spondylosis most prominent L3-4. L5-S1 disc protrusion , severe right neural foraminal narrowing, right and left degenerative facet change ligamentum flavum hypertrophy. L4-L5 disc bulge with overlying osteophytes, effacement of anterior thecal sac L3-L4 spondylolisthesis, osteophytes, severe left neural forminal narrowing, compression of left L4 nerve root L2-L3 severe left L2 neural forminal norrowing degenerative facet changes L1-L2 disc bulge extrusion extending cephalad, anterior thecal sac, degenerative facet, ligament flavum hypertrophy , foraminal norrowing , T12-L1 disc bulge degenerative facet, ligamentum hypertrophy lateral recess narrowing The MRi was only of lumbar area though I ask to include down to coccyx. Spine dr - PA suggested epidural (did not help) sent copy of MRI to Texas Spine in Dallas, Tx mentioning concern CES have not visited I live 200 mi away Many dr there. A doctor replied don't think you have CES but referred to another dr that maybe my fecal trouble is due to coccyx bent(which does show on MRI) and other pain may be due to 19% scolocsis curve which is not even mentioned in MRI notes. I am in rotating pain ALL DAY LONG What type of surgery is done for CES and how invasive is it.

[@skippy9659]

Just don’t expect a fusion to save you, bcuz it doesn’t always and it can go wrong.

[@collarrain9702]

Ju got 2 epidural injections within a week. Temp relief for all the symptoms you just described. MRI shows leak from a cyst but Dr doesn’t think surgery is the option any thoughts? Agony

[@DrBrianSuTheSpineGuy]

Watch the lumbar synovial cyst video

[@donnagarey8401]

Dr. I get this sudden almost electrical feeling from my belly button to my back, down my entire legs, weakness and pain. It's sudden and can happen sitting or standing and I can't determine what causes it. I just know that it feels like a bolt of lightning hits me and everything goes numb. I'm getting so tired of being like this 😢

[@DrBrianSuTheSpineGuy]

It sounds like you need an MRI The lumbar spine but you should get in front of a spine doctor.

[@FusedandFit]

I experienced this (cauda equina) 14 years ago. I had already had a discectomy 1.5 years earlier. I was playing basketball and a guy landed on me, and by the end of the day I could not walk and my legs were having spasms. I had other issues too (loss of bladder control) and ended up in the emergency room having another discectomy. I was immediately better. They said I was lucky to get in when I did. And you're right, when I mentioned bladder issues they got me right in. 14 years later I've had two back fusions (neck and toe fusion too), and am actually doing really well. Your video is spot on with my cauda equina experience.

[@mahmoudabualfa3347]

do you returned your sexual function? Please answer me

[@charliejg]

Very well explained and detailed video. Thanks for taking the time to create it. Question: I have radiculopathy in my right arm, pain in neck and around the right scapula. MRI of course shows cervical stenosis of the central canal and foraminal stenosis as well. A four level ACDF has been recommended by a neurosurgeon. Lately I've noticed some tingling at the back of my tongue on the right side. Is there any relationship between cervical stenosis and tingling of the tongue? Secondly, do you believe ACDF is still the gold standard or are there new procedures with enough longitudinal data show positive results to consider them? Thank-you...

[@AndyL940]

Hi , I’m 56 and have same as you central stenosis from 4/5/5/6/6/7/ and 5 foraminal openings severely closed over with shoulder and scapula pain . My cord is not actually compressed however all the fluid front and rear is squeezed out. I’m being watched for the time being. I have facial tingling and in my ear and my lips sometimes. I wouldn’t be surprised if it’s your stenosis causing it .I have lots of weird things happening to me . Best wishes. Our journey continues.

[@charliejg]

@@AndyL940 Sounds like we're in the same boat in terms of the cord and fluid as you explained it. I'm also being watched. I was told my my neurosurgeon that surgery isn't some I need tomorrow, but he wouldn't wait four or five years either because it doesn't get better. I've researched so many different methods out there that sound good, but aren't accepted by the medical community at large. ACDF has been the gold standard for a long time. It would be great if some new technology was perfect that eliminated the need for fusion though.

[@DrBrianSuTheSpineGuy]

You can Make a virtual appointment by calling 415-925-8200

[@mahmoudabualfa3347]

does the age make different in recovering? and it is a lifetime disease?

[@DrBrianSuTheSpineGuy]

It is more about physiologic age meaning how healthy you are versus biological age meaning how old you actually are. In general we try not to do surgery on people over 80 to 85 these days

[@Bikkufootballtalks]

Doctor i recently did a blood test my vitamin b12 is low. Also suffering from urine urgency and i have disc bulge and sciatica nerve pain' but not much pain as at starting. Recently i had urine urgency started and my pain is shifting from left side to right side back.(It's been 2years of slip disc and scaitica pain ) I did chiropractor

[@juliestewart9842]

I have told the ER on at least 3 visits in the past 9 months that I have saddle anesthesia, bilateral radiculopathy, some bowel leakage and I don't feel it when I pee or have a bm. They don't care. I've also told my PCP and a neurosurgeon and pain management dr. Still no concern. I have spondylolisthesis at L4 L5 but on MRI it doesn't show any compression at that level. I do have significant narrowing at the L2 L3 due to a bulging/herniated disc and severe ligamentum flavum hypertrophy. Altho it is not reported on the findings of the MRI. And I've asked at least 4 of the drs i've seen in the past 6 months to review the MRI but none of them will. I am so at a loss anymore. My entire right foot is numb, tingly, and tight all the time. I'm also now to the point I can hardly walk more than 10-15 steps without needing to sit down. And not 1 dr even cares. Like I said, they don't see anything wrong at the L4 L5 so I'm assuming they aren't willing to look higher up. IDK if I have sexual dysfunction because for the past year I have not been able to find a comfortable enough position to attempt it, so I've gone without.

[@skippy9659]

So, I had L5S1 severe disc damage, where originally the disc broke apart and part went up and stopped in thoracic area. fusion and had foot drop prior. I’ve been messed up since. I currently feel like my sphincter is in constant state of like, it’s ON, flexed, I don’t know the terms…and I have to consciously release it, it’s always in flex?? Weird, but I do have severe sacrum pain as well. Some saddle numbness as well. I have a screw that was too long, leading to protrusion, probably grade 3. I’ve been told by two neurosurgeons not to let anyone touch me again. Oh and I have Infuse which was used, so I know there were problems with that, it was used in my surgery 2012 before they knew everything about it.

[@jminsandiego]

Thank you for another very informative video, Dr. Su. Well done!

[@amigatommy7]

My L3, 4, 5 and S1 would not agree pain - wise

[@Noonecare86]

Wow Wow Wow Just Wow 🎉❤❤ Thank you Sir

[@ahwell9984]

So interesting. Thanks.

[@Sklipchan]

Dr. Su, since the spinal cord ends at L1, does it mean there’s a lower risk of spinal fluid leak in a surgery involving the lower lumbar?

[@DrBrianSuTheSpineGuy]

No there is a same risk of spinal fluid leak

[@redleader]

Exceellent video Dr. Su. i have intermittant CES. When I stand on concrete for 5-7 mins I begin to feel the numbness and tingling from my waistline down. But it is immediately relieved when I sit or bend forward. I have been to 2 spine surgeons and both say there's no CES. But my PT person was shocked and scared for me. What can I do? I cant walk in with my MRI and demand some type of surgery. Can I just live with it? I do not experience any sort of incontinence. When I fee the "saddle anethisia" onset...I just find a chair fast!

[@DrBrianSuTheSpineGuy]

I would have to look at the imaging study. Please call 415-925-8200

[@fredsnyder3002]

I am in my eighties and have been diagnosed with cervical spinal stenosis C3-C5 and am considering surgery. Looking for information about the procedure I found that there is a new ultrasonic technique to remove the stenosis. Is this a viable option compared to the traditional laminectomy?

[@DrBrianSuTheSpineGuy]

Watch the playlist on cervical stenosis. Ultrasonic tools are just fine to use but really have shown no benefit over other methods of removing bone

[@nanaykikay8017]

Dr. Su, please discuss c4-c7 spinal cord compression 6:27 up to what extent to heal on its own or should i do surgery? Please help me dr. Su🙏

[@DrBrianSuTheSpineGuy]

Watch the video on cervical stenosis do I really need surgery? You could always call for 415-925-8200 for a second opinion with me

[@Kreacher1974]

This was one of my issues causing me to have surgery. I've had 3 major back surgeries since April 2022. Before the back surgeries and the ACDF in my neck I had 13 herniated discs. Since my back surgeries my right quad muscle and my right leg is extremely weak. Dr also said I have OPLL.

[@randolphreid266]

I have CES but from a cyst at Facet joint at T3. How is that?

[@DrBrianSuTheSpineGuy]

There is no Cauda there so in that situation it would be issues related to the spinal cord

[@FreeRansom101]

I’m 26 and have had sciatica pain on left side for 4 years. My left foot tingles and can feel numb from time to time. But I can still flex and move left leg with ease. No urination problems. If anything I pee a lot. Should I be worried about this?

[@DrBrianSuTheSpineGuy]

You should get an MRI of the lower lumbar spine and see a spine doctor

[@FreeRansom101]

@@DrBrianSuTheSpineGuy I got a mri awhile ago and just showed my two herniated discs. But they didn’t seem worried about anything else. But Can a disc get worse and eventually bother the causda equina?

[@neelamr30]

Mine L4 L5 S1 bulg and press nerves

[@JohnJones-ff4nu]

Can you do an episode on DISH syndrome???????

[@DrBrianSuTheSpineGuy]

Yes

[@JohnJones-ff4nu]

Please cover prognosis and diet guidelines to minimize DISH progression.

[@angeloscaravilrspadilla7269]

Greetings Doctor Su. Can you tell me if you accept military Tricare for life. Thank you and have a great day!

[@DrBrianSuTheSpineGuy]

I believe we do