Spine Health & Spinal Hygiene

Cauda equina syndrome is an emergency that needs to be treated as soon as possible. It is a form of spinal nerve compression, but if left untreated, it can lead to permanent paralysis of one or both legs and permanent loss of bowel/bladder control. Lower back pain after sitting for too long or improperly lifting something heavy happens to most if not all of us.

However, sometimes pain in the lower back can be an indicator of something more serious. Especially, for individuals that are dealing with or managing back pain. One condition is cauda equina syndrome. It’s not like sciatica or arthritis, but it does have specific symptoms that individuals should be aware of.

Cauda Equina Syndrome

The term comes from Latin that means horse’s tail. The cauda equina forms the group of nerves that run through the lumbar spinal canal. Generally, the condition means two things:

• There is nerve compression of most of the lumbar spinal canal
• Compression symptoms like numbness or weakness in the leg/s

How cauda equina syndrome differs from typical compression of the lumbar spinal canal is that it can be caused by different issues, from fractures, tumors, and infections. More commonly, it is disc herniations that cause the problems. The key difference is the degree of nerve compression, and the number of nerves compressed.

For example, compression of a single nerve will not cause loss of bladder function. But compression of multiple nerves, especially the sacral nerves can cause loss of function. Nerve compression that leads to pain or numbness can be treated differently. Surgery is reserved for severe cases and for individuals that are not improving with non-invasive treatment.

Sneaky Presentation

One of the major factors is long-term compression that individuals do not realize they have. Individuals are more likely to be aware of symptoms from another spinal condition before cauda equina syndrome presents. However, the condition presents quickly but often other overlapping back problems mask cauda equina syndrome.

Causes

The syndrome can be brought on from anything that compresses the nerves. Most commonly, it is a root compression from degenerative processes, specifically lumbar disc herniations. Other causes include:

• Bleeding like an epidural hematoma
• Trauma like fractures or penetrating trauma
• Tumors growing in the canal or the collapse of a tumor-affected bone
• Disc herniations can progressively grow in size, which leads to a slowly-evolving cauda equina syndrome.
• An enlarging disc herniation or synovial cyst can further compromise the already compressed nerves.
• Overgrowth of arthritic joints or bone spurs into the spinal canal can lead to long-term compression.

Symptoms

The symptoms vary based on the degree that the spinal canal has been affected:

• Back pain
• Leg pain
• Sciatica
• Saddle numbness that extends into other areas of the legs
• Neurogenic bladder dysfunction. This can range from difficulty starting to urinate or limited and/or non-voluntary control urinating.
• Bowel dysfunction
• Sexual dysfunction

Diagnosis

A doctor will examine any significant changes in bladder, bowel, or leg function that are considered red flags prompting an early and complete assessment. A physician will ask for a complete/detailed history of the onset and progression of symptoms.

The second is a close physical examination which includes testing sensation and strength along with a rectal exam to assess voluntary contraction. Also checking the body's reflexes, assess walking gait and alignment. If most or all of the symptoms are presenting this will set in motion spinal imaging or an MRI. If the symptoms, exam, and imaging match, it will lead to an emergency admission to the hospital.

Body Composition Spotlight

Obesity and Osteoarthritis Connection

A variety of factors contribute to the development of osteoarthritis, including genetic factors and lifestyle choices. Research supports obesity is a significant risk factor in the development of osteoarthritis. It is pretty straightforward as body weight increases this equals increased load on the spine, and joints, especially the weight-bearing ones like the hips and knees. Increased pressure leads to early wearing, tearing, and eventual development of osteoarthritis. Added weight affects the body's biomechanics and gait patterns.

However, obesity has also been shown to be a risk factor even on the non-weight-bearing joints. This is based on adipose tissue, which is more than just insulation. Adipose tissue is metabolically active and is involved in the secreting adipokines and cytokines which promote an inflammatory response. Pro-inflammatory adipokines and cytokines can have detrimental effects on joint tissue including damage to cartilage, synovial joints, and subchondral bone. The effect of inflammation on the joints in the body can contribute to the development of osteoarthritis.

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

References

Causes of Cauda Equina: Neurosurgical Focus. (June 2004) “Spinal epidural hematoma causing acute cauda equina syndrome” https://pubmed.ncbi.nlm.nih.gov/15202871/

Arriving at a Diagnosis: British Journal of Neurosurgery. (August 2010) “Reliability of clinical assessment in diagnosing cauda equina syndrome” https://www.tandfonline.com/doi/abs/10.3109/02688697.2010.505987

Back pain is a daily issue for millions of Americans, with a variety of medial issues being the culprit. The results of lower back pain on the economy as a whole are far reaching, from tons of lost work time to enormous medical costs. Maignes Syndrome is estimated to be the cause of a great deal of the instances of lower back pain.

Never heard of it? Lucky you because those who are diagnosed with Maignes Syndrome suffer pain that sometimes lasts for weeks or even months, and can become quite severe. Discomfort is increased sometimes when the patient twists his torso, or lifts a heavy object.

What Is Maignes Syndrome?

Also called Thoracolumbar Junction Syndrome, Maignes Syndrome is a spinal disorder that is located in the nerves in the upper lumbar region of the back, causing pain to radiate along the nerves from the site. This spinal condition creates difficult to diagnose symptoms, since it often results in pain in a different part of the body than the actual source. It is believed this "condition exists because of the facet joint issues at the junction between the middle spine and lower spine.". The pain from Maignes Syndrome usually shows up in the hip, lower back, or groin.

If you are experiencing lower back pain, you may suffer from Maignes Syndrome. Schedule a chiropractic visit as soon as possible, because a chiropractor benefits Maignes Syndrome sufferers in four important ways.

Doctor Of Chiropractic Can…

…Help Correctly Diagnose It

Unfortunately, the nature of the pain and location of the condition frequently cause Maignes Syndrome to be misdiagnosed. Sacroiliac joint pain is sometimes the diagnosis they receive, which hinders proper treatment. For this reason, the patient needs to make certain they are working with an experienced chiropractor who understands the subtle differences of the two conditions.

…Adjust The Area Where The Issue Originates

In order to minimize the symptoms of the condition, a chiropractor can administer adjustments on and around the area causing the issue, the thoracolumbar facet joints. Aligning this area correctly, and loosening the area that may have become tight from overcompensation, assists in relieving pain from Maignes Syndrome.

…Offer At Home Exercises To Help With Healing

Fortunately, there are exercises that can aid Maignes Syndrome, both in loosening the tightness of the afflicted area, and building up the surrounding muscle strength so the body can compensate for the issue. A chiropractor who understands this spinal condition can walk you through a step-by-step exercise regimen of the types of exercises that will help your body adapt to and heal from Maignes Syndrome.

…Promote Your Body's Ability To Heal Itself

Chiropractic care is a broad-based approach to the body's inner function and balance. Experienced chiropractors understand that all parts fit together for overall health. A patient with Maignes Syndrome benefits from chiropractic care because of this.

Your chiropractor will make a series of adjustments that help the nervous system work at optimum capacity, which promotes healing to the entire body. Attacking Maignes Syndrome directly at the site and through the body as a whole promotes faster healing and increased mobility.

Individuals with Maignes Syndrome unfortunately face an uphill battle that begins with being correctly diagnosed. The complexity of the spinal condition is the primary reason to seek a professional chiropractor's opinion at the first sign of ongoing lower back pain. Once Maignes Syndrome is correctly pinpointed, the chiropractor will be able to design an in-house and at-home blend of treatment options to minimize your healing time and achieve a pain-free, fully functioning back.

Chiropractic Treatment Helps Avoid Back Surgery

Before and after spine surgery the surgeon and medical staff prepare you for recovery. The recovery process can take a long time and be extremely challenging.

Pain after spine surgery is normal, but how to tell if it’s beyond the typical pain during recovery?

What indicates that the surgery failed?

Chiropractor Dr. Alex Jimenez has dealt with this issue throughout his career and discusses symptoms associated with failed back surgery syndrome (FBSS, also known as failed back surgery (FBS) or post-laminectomy syndrome).

Back Pain the most common symptom

Chronic back pain is the most common symptom from failed back surgery.

With FBSS, chronic pain in one patient can be very different from pain in another.

People with FBSS can experience a range of different types of pain based on:

• Spinal disorder
• Spinal procedure
• The underlying cause of failed back surgery syndrome

Types of back and neck pain people with failed back surgery may experience. Some may have one or more types. 

Chronic pain:

• Sustained pain that lasts for more than 12 weeks.
• Chronic pain is the opposite of acute pain, which is short-term severe pain.
• Acute pain is expected during spine surgery recovery but should fade during the healing. 

Nociceptive pain:

Localized pain that can be dull or sharp.

This is the type of pain patients may experience immediately after surgery

Example: The pain felt around where the incision was made.

When most people think of pain, nociceptive pain is the type.

Neuropathic pain (neuropathy):

Nerve-related pain is caused by damage to the nerves or spinal cord.

Neuropathic pain shoots and moves around, thus affecting large areas of the body.

Examples of this type of pain include:

• Numbness
• Burning
• Tingling
• Weakness
• Abnormal sensations (called paresthesia)

Radicular pain (radiculopathy):

A branch of nerve pain (neuropathy) is called radiculopathy, or radicular pain.

Radicular pain radiates from one area to another.

Examples include from the:

• Low back
• Down the buttocks
• Legs
• Feet

And then starts all over again, or goes in a different order.

Other symptoms:

The original symptoms return:

When the symptoms that put the patient in the surgery room return, then there is a definite possibility of failed back surgery. 

New pain presents:

New pain, meaning pain in a different part of the spine or a different type merits a discussion with your doctor.

Mobility Reduced :

It does take time to recover and that process can affect:

• Endurance
• Flexibility
• Movement

However, if mobility or limitation is different from what was talked about with the surgeon or develops after recovery, then it should be discussed with your doctor.

Example: A limited range of motion in the neck or low back.

Headaches begin to present:

If headaches were not an original part of your medical history, this may point to a nerve problem. 

Nerve Symptoms & Quality of Life

Neuropathic pain/ neuropathy or nerve-related pain is the most complex, debilitating, and difficult-to-treat.

People who experience this type of pain find it lowers their quality of life.

An online survey of 1,000-2000 patients that underwent low back surgery responded and revealed the following:

1. 94% of respondents reported post-surgery low back pain
2. 71.1% dull achiness
3. 69.8% numbness
4. 43.3% cold sensations
5. 35.3% paresthesia (eg, burning, tingling, pricking sensations)

A separate study noted that nerve-related pain suffered by people with FBSS is more life-altering than pain caused by joint and nerve disorders.

Patients with FBSS and neuropathic pain go through higher levels of pain and have less quality of life/physical function compared with people with osteoarthritis, rheumatoid arthritis, and fibromyalgia.

FBS Symptoms Emergency Treatment

After surgery, it can be difficult to tell whether the pain is within the bounds of normal recovery pain.

At follow-up appointments ask questions about the progress of your recovery and about any concerns.

Pain after surgery is normal, but there are some signs and symptoms that merit emergency attention.

If you experience any of the red flag symptoms, call your doctor immediately:

• New weakness
• Difficulty walking
• Electric pain in the lower body
• Fever
• Vomiting
• Unintentional weight loss
• Loss of bowel or bladder function

This can be a sign of a spinal nerve disorder called cauda equina syndrome. 

Symptoms of Failed Back Surgery Syndrome Are Different for Every Patient

• Every patient goes through a unique surgical experience and if it fails, patients may experience unique symptoms.
• Because failed back surgery has several possible causes, the symptoms are going to be different for each patient.
• Before you are discharged and even before you go under, ask your surgeon questions about what to expect during the recovery process.
• Educating yourself with possible expectations during recovery, you’ll be best positioned to know when things aren’t going as they should.

Back Pain Management El Paso, TX Chiropractor 

Denise was involved in an auto accident which resulted in low back pain. When she realized she couldn't sit, walk or sleep for extended periods of time without experiencing painful symptoms, Denise found chiropractic care with Dr. Alex Jimenez in El Paso, TX.

Once she received treatment for her auto accident injuries, Denise experienced relief from her symptoms and she was able to perform her everyday activities once again. Thanks to the education and care Dr. Alex Jimenez provided, Denise regained her original health and wellness.

Back pain is common, with roughly nine out of ten adults experiencing it at some time in their life, and five from ten working adults developing it every year. Some estimate around 95 percent of Americans will experience back pain at some time in their lifetime.

It's by far the usual cause of chronic pain, as it is also a significant contributor to missed work and disability. In the United States alone, acute cases of lower back pain are the fifth most common reason for physician visits and cause 40 percent of missed days off work. Furthermore, it is the only leading cause of disability globally.