The importance of listening to my patients hit me full in the face this week.  On Monday, I had a new patient present with horrendous low back pain.  He had been to an Emergency Room the previous day, was examined, sent home, and told to take high doses of Ibuprofen.  He came to see me the next day because despite being a tough-as-nails saw mill worker, he could no longer tolerate the pain.  Although I see people in terrible pain each and every day I am in the office, this person also presented with........

• BILATERAL SCIATICA:   Any time SCIATICA is bilateral, it starts to raise a red flag.
  

• SADDLE PARESTHESIA:  He had abnormal sensation on the inside part of his legs that would come in contact with a saddle if he were riding a horse.

• TESTICULAR ANESTHESIA:  He could not feel his testicles. 

• ANAL ANESTHESIA:  He could not feel it when he wiped his rear end. 

• ANAL LEAKAGE:  He was leaking feces ---- and could not feel it happening. 

Any one of these is a potential Red Flag, but when put all together it is like a huge, glowing, UFO camped out just over your house.  I gave this individual a letter outlining my findings that took me two minutes to scrawl on office letterhead.  I also told him to go to a different Emergency Room and give the letter to whomever they came in contact with first --- immediately.  Mind you, I did not actually do an examination on this person.  There was no need.  I simply got this information from what he told me during a three minute consultation. 

I wrote on the letter that I believed he had CAUDA EQUINA SYNDROME; a serious condition that requires immediate surgical intervention. The cause of the Cauda Equina Syndrome?   After having an MRI done, they discovered a tumor pressing on his spinal cord. 

His wife called our office yesterday and told Tracy the story, who then relayed it to me.  He is scheduled for surgery later this month.  Needless to say, she was extremely grateful we actually took the time to listen to them; and then she thanked us for going out of our way to help him get the help that he needed. 

Interestingly enough, I had another patient whom I examined yesterday and who will start her Decompression Protocol on Monday.  She was excited because someone had actually "examined" her in a thorough fashion as opposed to a tap of her reflexes, bend forward, and here's a prescription for pain pills, muscle relaxers, and anti-inflammatory drugs.  Unlike him, I am completely convinced she is a GOOD CANDIDATE for Spinal Decompression and will get dramatically better with a good SPINAL DECOMPRESSION PROTOCOL.

WHAT IS THE CAUDA EQUINA?
The Cauda Equina (Latin for "Horse's Tail") is a bundle of nerves and nerve roots that occupies the spinal canal below the end of the spinal cord.  These are the nerves that control the legs.

Because the Spinal Vertebrates continue to grow into early adulthood while the spinal cord stops growing in infancy, the adult spinal cord ends at the top part of the low back (L1 - L2).  Individual spinal nerve roots come from the spinal cord as they do closer to the head, but as the differential growth occurs, the top end of the nerve stays attached to the spinal cord and the lower end of the nerve exits the spinal column at its proper level, this results in a "bundle"-like structure of nerve fibers that extend downward from the end of the spinal cord.  As nerve pairs leave exit the spinal cord from the INTERVERTEBRAL FORAMEN, this bundle of nerves that makes up the Cauda Equina gets smaller and smaller.

If you look at the picture above, you will see the end of the Spinal Cord (the Conus Medularis), with lots of nerves making up the Cauda Equina.  And yes, it really does look like a horse's tail.

SIGNS OF CAUDA EQUINA SYNDROME
The key thing to remember when diagnosing a suspected Cauda Equina Syndrome is that while it can present with terrible pain, it sometimes presents with NO pain.  The signs include many of the things that we see with traditional DISC HERNIATIONS:

• Weakness of Leg Muscles (often bilaterally)
• Paralysis of Legs (often bilaterally)
• Bilateral loss of Ankle Reflexes (Achilles / Tibialis Anterior)
• An Inability to Heel or Toe Walk
• Urine Retention
• Sexual Dysfunction
• Loss of Ability to Control the Bowel
• No Pain
  

However, the classic sign of Cauda Equina Syndrome is Saddle Anesthesia.  Saddle Anesthesia simply means that you have no feeling (or abnormal sensation) in the area a saddle would touch your lower body ---- your inner thighs / legs, buttocks, and perineum.  If you have Saddle Anesthesia & an Inability to Urinate, seek immediate Emergency Care!

WHAT CAUSES CAUDA EQUINA SYNDROME? 
Although rare, many of the same problems that are effectively treated by Spinal Decompression Therapy (SPINAL STENOSIS, LUMBAR DISC HERNIATION, or SEVERLY DEGENERATING DISCS) can cause Cauda Equina Syndrome.  But like I said, fortunately, CES is rare.  Research tells us that slightly under 1 in 50 of the most invasive Spinal Surgeries (Laminectomies and Spinal Fusions) are done because of Cauda Equina Syndrome.

WHAT DO I DO IF I AM DIAGNOSED WITH CAUDA EQUINA SYNDROME?
Cauda Equina Syndrome is a rare, but highly serious Medical Emergency.  Although some degree of bowel dysfunction is common with all sorts of back problems including SUBLUXTION, DISC DEGENERATION, DISC HERNIATION, and SPINAL STENOSIS, it is usually diarrhea or constipation (more often than not it's the latter).  If you have this and any of the group of symptoms listed above in red, it is imperative that you contact your nearest Emergency Room immediately.   The quicker you get to a surgeon, the better chance you have of not being left with permanent nerve damage!

Cauda Equina Syndrome is just one of the many problems we screen for before starting a SPINAL DECOMPRESSION PROTOCOL.  Like I have said before; NOT ALL PATIENTS WITH SPINAL PROBLEMS ARE CANDIDATES for Spinal Decompression Therapy.  Once it has been determined that this rare problem is not the cause of your back pain, it's important to figure out what is. 

Rather than opting for Spinal Surgeries and their POOR TRACK RECORD, call us at (417) 934-6337 to see set up a free, no-obligation consult.  We will review your history and diagnostic imaging (X-rays, CT Scans, MRI's, Discograms, Meylograms, etc), and determine whether moving forward to an examination is even an option.