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Jeffrey Turner SPT, CSCS
Junsik Yoon SPT
 5th most common condition
 ~25% adults report LBP w/in past 3
months
 Prevalence of 70% over the course of
one’s life
 >85% cannot be reliably attributed to
a specific disease or abnormality
 Classified into 3 broad categories:
1. Nonspecific LBP
2. Nerve Root Syndrome (CES, etc.)
3. Serious Spinal Pathology
Images Courtesy of www.ericcressey.com
 Less common than nonspecific
 Potentially disabling condition
 Most often caused by acute lumbar
disc herniation
 Commonly between ages of 30 – 55
 Related to:
 Radiculopathy
 Spinal Stenosis
 Cauda Equina Syndrome
Images Courtesy of www.publichealthwatchdog.com
Cauda equina syndrome
 Rare and devastating condition
 Prevalence of ~0.04% of all patients
presenting w/ LBP
 “True neurologic emergency”
 Rapid clinical progression
 For optimal prognosis:
 Early recognition/diagnosis
 Immediate surgical referral
 Recommended w/in 48 hours of Dx
Images Courtesy of www.publichealthwatchdog.com
Cauda equina syndrome
32 year old male presented to a PT at
a medical aid station in Iraq.
 Convoy machine gunner
 Prolonged periods of standing >8 hrs
 Wearing equipment up to ~80 lbs
 4 week history of insidious onset and
recent worsening of:
 Low back pain
 Left buttock pain
 Posterior left thigh pain
 Goal: Decrease pain during work
Images Courtesy of www.defense.gov
 Pain: 4/10 resting and 7/10 at worst
 Hx: 3-4 prior occurrences of LBP
 Physical Exam:
 Neurologically intact, and negative SLR
 Limited lumbar flexion AROM
 Reduction of Sx w/ lumbar extensions
 Findings consistent w/ nonspecific LBP
 No red flag signs or symptoms
 Treatment:
 Prescribed extension-oriented exercises
 Prescribed NSAIDs for pain
 Patient education
 New Symptoms:
 Saddle anesthesia, LE paresthesia
constipation, and urinary hesitancy.
 Physical Exam:
 Right plantar flexor weakness, absent
right ankle reflex, and decreased anal
sphincter tone.
 Findings consistent w/ CES
 Referral:
 Medically evacuated to neurosurgeon
 L4-5 Laminectomy/decompression w/in
48 hours of CES diagnosis
Returned to full military duty 18
weeks after surgery without back or
lower extremity symptoms or
neurological deficits.
 Demonstrates the importance of
medical screening.
 Demonstrates the importance of
immediate referral to surgical
specialties when CES is suspected.
 Rapid intervention offers the best
prognosis.
Images Courtesy of www.englishrussia.com
 Spinal cord ends between vertebrae L1 & L2
 Originates after Conus Medullaris
 L2 to S5 nerve roots looks like horse’s tail
 Includes motor nerves, sensory nerves and
parasympathetic innervation of the bladder
Images Courtesy of Clinically Oriented Anatomy
 Compressive causes
 Herniated lumbosacral disc
 Spinal stenosis
 Spinal neoplasm
 Fracture of vertebrae
 Non-compressive causes
 Ischemia
 Infection
 inflammation
Image Courtesy of www.publichealthwatchdog.com
Images Courtesy of www.publichealthwatchdog.com
 Making a thorough evaluation
 Continually monitoring patient’s status throughout the patient management
 Acting appropriately when conditions emerge that requires immediate referral
Image Courtesy of www.bu.edu
Cauda equina syndrome
 Crowell MS, Gill NW. Medical Screening and Evacuation: Cauda Equina
Syndrome in a Combat Zone. J Orthop Sports Phys Ther. 2009; 39(7):541-549.
 Moore KL, Dalley AF, Agur AMR, et al. Clinically Oriented Anatomy 7th Edition.
Lippincott Williams & Wilkins; 2013.

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Cauda equina syndrome

  • 1. Jeffrey Turner SPT, CSCS Junsik Yoon SPT
  • 2.  5th most common condition  ~25% adults report LBP w/in past 3 months  Prevalence of 70% over the course of one’s life  >85% cannot be reliably attributed to a specific disease or abnormality  Classified into 3 broad categories: 1. Nonspecific LBP 2. Nerve Root Syndrome (CES, etc.) 3. Serious Spinal Pathology Images Courtesy of www.ericcressey.com
  • 3.  Less common than nonspecific  Potentially disabling condition  Most often caused by acute lumbar disc herniation  Commonly between ages of 30 – 55  Related to:  Radiculopathy  Spinal Stenosis  Cauda Equina Syndrome Images Courtesy of www.publichealthwatchdog.com
  • 5.  Rare and devastating condition  Prevalence of ~0.04% of all patients presenting w/ LBP  “True neurologic emergency”  Rapid clinical progression  For optimal prognosis:  Early recognition/diagnosis  Immediate surgical referral  Recommended w/in 48 hours of Dx Images Courtesy of www.publichealthwatchdog.com
  • 7. 32 year old male presented to a PT at a medical aid station in Iraq.  Convoy machine gunner  Prolonged periods of standing >8 hrs  Wearing equipment up to ~80 lbs  4 week history of insidious onset and recent worsening of:  Low back pain  Left buttock pain  Posterior left thigh pain  Goal: Decrease pain during work Images Courtesy of www.defense.gov
  • 8.  Pain: 4/10 resting and 7/10 at worst  Hx: 3-4 prior occurrences of LBP  Physical Exam:  Neurologically intact, and negative SLR  Limited lumbar flexion AROM  Reduction of Sx w/ lumbar extensions  Findings consistent w/ nonspecific LBP  No red flag signs or symptoms  Treatment:  Prescribed extension-oriented exercises  Prescribed NSAIDs for pain  Patient education
  • 9.  New Symptoms:  Saddle anesthesia, LE paresthesia constipation, and urinary hesitancy.  Physical Exam:  Right plantar flexor weakness, absent right ankle reflex, and decreased anal sphincter tone.  Findings consistent w/ CES  Referral:  Medically evacuated to neurosurgeon  L4-5 Laminectomy/decompression w/in 48 hours of CES diagnosis
  • 10. Returned to full military duty 18 weeks after surgery without back or lower extremity symptoms or neurological deficits.  Demonstrates the importance of medical screening.  Demonstrates the importance of immediate referral to surgical specialties when CES is suspected.  Rapid intervention offers the best prognosis. Images Courtesy of www.englishrussia.com
  • 11.  Spinal cord ends between vertebrae L1 & L2  Originates after Conus Medullaris  L2 to S5 nerve roots looks like horse’s tail  Includes motor nerves, sensory nerves and parasympathetic innervation of the bladder Images Courtesy of Clinically Oriented Anatomy
  • 12.  Compressive causes  Herniated lumbosacral disc  Spinal stenosis  Spinal neoplasm  Fracture of vertebrae  Non-compressive causes  Ischemia  Infection  inflammation Image Courtesy of www.publichealthwatchdog.com
  • 13. Images Courtesy of www.publichealthwatchdog.com
  • 14.  Making a thorough evaluation  Continually monitoring patient’s status throughout the patient management  Acting appropriately when conditions emerge that requires immediate referral Image Courtesy of www.bu.edu
  • 16.  Crowell MS, Gill NW. Medical Screening and Evacuation: Cauda Equina Syndrome in a Combat Zone. J Orthop Sports Phys Ther. 2009; 39(7):541-549.  Moore KL, Dalley AF, Agur AMR, et al. Clinically Oriented Anatomy 7th Edition. Lippincott Williams & Wilkins; 2013.