Cauda Equina: Difference between revisions

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== Introduction ==
== Introduction ==
The spinal cord ends around L1, consequently, the caudal nerve roots below the first lumbar root, form the cauda equina. The roots descend at an almost vertical angle to reach their corresponding foramina, gathered around the filum terminale within the spinal theca. The proximal portion of the cauda equina is said to be hypovascular hence more vulnerable if compressed . The cauda equina roots have both a dorsal and ventral root. The ventral root provides motor fibres for the efferent pathway along with sympathetic fibres. The dorsal root is composed of afferent fibres for the transmission of sensation. The functions of those nerves are:
[[File:Cauda equina.jpeg|thumb|Cauda equina]]
The cauda equina is a collection of spinal nerves that travel through the lumbar cistern as they leave the vertebral column. The spinal cord is shorter than the vertebral column, which causes nerves that innervate the lower limbs to bundle together as they travel down through the vertebral column to leave at the appropriate level. It is so named as it resemble a horse’s tail. Just above the cauda equina, the spinal cord ends and it continues on as this collection of spinal nerves through the vertebral canal.


* Sensory and motor fibres to the lower limbs.
== Anatomy ==
* Sensory innervation to the saddle area.
The spinal cord ends around L1, consequently, the caudal nerve roots below the first lumbar root, form the cauda equina. The roots descend at an almost vertical angle to reach their corresponding foramina, gathered around the filum terminale within the spinal theca. The proximal portion of the cauda equina is said to be hypovascular hence more vulnerable if compressed . The cauda equina has approximately 10 fiber pairs at its base. These consist of 3 to 5 lumbar fiber pairs, 5 sacral fiber pairs, and 1 coccygeal nerve. The primary function of the cauda equina is to send and receive messages between the lower limbs and the pelvic organs, which consist of the bladder, the rectum, and the internal genital organs.
* Voluntary control of the external anal and urinary sphincters.


Aspects of anatomical features relating to saddle sensation, bladder, bowel and sexual function are discussed below;
The cauda equina roots have both a anterior and posterior root.


The first three sacral nerves, S1,2 and 3 supply multifidus and lateral cutaneous branches to the skin and fascia over the sacrum and part of the gluteal region. The 4th and 5th sacral nerves, S4 and 5, along with posterior primary ramus of the coccygeal nerve supply the skin and fascia around the coccyx. The pelvic splenic nerves to the pelvic viscera composed of parasympathetic fibres, travel in the ventral rami of S2,3 and 4. They then leave these nerves as they exit the anterior sacral foramina and pass to the pre-sacral tissue. Some pass to the pelvic viscera alongside the pelvic sympathetic supply and supply the urogenital organs and distal aspect of the large intestine. Others pass immediately into retroperitoneal tissue and into the mesentry of the sigmoid and descending colon . The pudendal nerve supplies the perineum and arises from S2,3 and 4 with its terminal branches including the dorsal nerve of the penis or clitoris.<ref>Standring, S (ED IN CHIEF) Grays Anatomy, the anatomical basis of clinical practice 40th edition Churchill Livingstone Elsevier, 2008.</ref><ref>Parke WW, Gammell K, Rothman RH. Arterial vascularization of the cauda equina. J Bone Joint Surg Am 1981; 63: 53–62.</ref><ref>Brash J Jamieson E,(ed) Cunninghams Text book of Anatomy 7th edition. Oxford Medical Publications. 1937.</ref>
# The anterior rami of these spinal nerves contribute to the lumbar and sacral plexuses, which provide motor and sensory innervation to the entire lower limb, pelvic and perineal regions.
# Through their posterior rami, these spinal nerves supply the skin and deep muscles of the lower back, as well as sacral and coccygeal regions<ref name=":0">Ken hub Cauda equina Available:https://www.kenhub.com/en/library/anatomy/conus-medullaris-medullary-cone-and-cauda-equina (accessed 29.4.2022)</ref>.


== Sub Heading 2 ==
Additionally, the cauda equina provides parasympathetic innervation to the viscera of the pelvic cavity and perineum, including the urinary bladder, descending and sigmoid colon, rectum and both the internal and external reproductive organs. This parasympathetic innervation is also involved in the stimulation of erectile tissues of the external genitalia, enabling erection of the penis/clitoris.<ref>Healthline Cauda equina Available: https://www.healthline.com/human-body-maps/cauda-equina#1<nowiki/>(accessed 29.4.2022)</ref>.<ref>Standring, S (ED IN CHIEF) Grays Anatomy, the anatomical basis of clinical practice 40th edition Churchill Livingstone Elsevier, 2008.</ref><ref>Parke WW, Gammell K, Rothman RH. Arterial vascularization of the cauda equina. J Bone Joint Surg Am 1981; 63: 53–62.</ref><ref>Brash J Jamieson E,(ed) Cunninghams Text book of Anatomy 7th edition. Oxford Medical Publications. 1937.</ref>
 
== Physio Significance ==
[[Cauda Equina Syndrome|Cauda equina syndrome]]: Cauda equina syndrome is caused by a compression or irritation of lumbosacral spinal nerve roots, often due to lumbar disc herniation<ref name=":0" />.


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Revision as of 05:50, 29 April 2022

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Introduction[edit | edit source]

Cauda equina

The cauda equina is a collection of spinal nerves that travel through the lumbar cistern as they leave the vertebral column. The spinal cord is shorter than the vertebral column, which causes nerves that innervate the lower limbs to bundle together as they travel down through the vertebral column to leave at the appropriate level. It is so named as it resemble a horse’s tail. Just above the cauda equina, the spinal cord ends and it continues on as this collection of spinal nerves through the vertebral canal.

Anatomy[edit | edit source]

The spinal cord ends around L1, consequently, the caudal nerve roots below the first lumbar root, form the cauda equina. The roots descend at an almost vertical angle to reach their corresponding foramina, gathered around the filum terminale within the spinal theca. The proximal portion of the cauda equina is said to be hypovascular hence more vulnerable if compressed . The cauda equina has approximately 10 fiber pairs at its base. These consist of 3 to 5 lumbar fiber pairs, 5 sacral fiber pairs, and 1 coccygeal nerve. The primary function of the cauda equina is to send and receive messages between the lower limbs and the pelvic organs, which consist of the bladder, the rectum, and the internal genital organs.

The cauda equina roots have both a anterior and posterior root.

  1. The anterior rami of these spinal nerves contribute to the lumbar and sacral plexuses, which provide motor and sensory innervation to the entire lower limb, pelvic and perineal regions.
  2. Through their posterior rami, these spinal nerves supply the skin and deep muscles of the lower back, as well as sacral and coccygeal regions[1].

Additionally, the cauda equina provides parasympathetic innervation to the viscera of the pelvic cavity and perineum, including the urinary bladder, descending and sigmoid colon, rectum and both the internal and external reproductive organs. This parasympathetic innervation is also involved in the stimulation of erectile tissues of the external genitalia, enabling erection of the penis/clitoris.[2].[3][4][5]

Physio Significance[edit | edit source]

Cauda equina syndrome: Cauda equina syndrome is caused by a compression or irritation of lumbosacral spinal nerve roots, often due to lumbar disc herniation[1].

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References[edit | edit source]

  1. ↑ 1.0 1.1 Ken hub Cauda equina Available:https://www.kenhub.com/en/library/anatomy/conus-medullaris-medullary-cone-and-cauda-equina (accessed 29.4.2022)
  2. ↑ Healthline Cauda equina Available: https://www.healthline.com/human-body-maps/cauda-equina#1(accessed 29.4.2022)
  3. ↑ Standring, S (ED IN CHIEF) Grays Anatomy, the anatomical basis of clinical practice 40th edition Churchill Livingstone Elsevier, 2008.
  4. ↑ Parke WW, Gammell K, Rothman RH. Arterial vascularization of the cauda equina. J Bone Joint Surg Am 1981; 63: 53–62.
  5. ↑ Brash J Jamieson E,(ed) Cunninghams Text book of Anatomy 7th edition. Oxford Medical Publications. 1937.
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