Ponytail syndrome: symptoms and treatment

Back pain, movement disorders, sexual dysfunction, worsening of the bladder and rectum, and others unpleasant sensations in the lower spine and in the legs - these symptoms are familiar to many patients and are often found in the complex. Scientists drew attention to this and combined this complex of painful manifestations into one with a figurative name: horse tail syndrome.

As you know, the syndrome in medicine and psychology is called a number of symptoms, which often manifest themselves together and are, thus, the manifestation of a single disease or its stage. In this article, we will examine the symptoms and treatment of horse tail syndrome, a fairly difficult treatable ailment.

Structure of the spinal column

In the vertebral canal, the spinal cord is located, which ends at the level of the 2nd lumbar vertebra (L II). Below are the roots of the spinal nerves that emerged from the segments of the spinal cord. The roots of the four lower lumbar, five sacral and coccygeal spinal nerves form the so-called ponytail (in view of the similarity with the horse's tail). It is nothing but a bundle of nerve endings and canals. It is located in the lower part of the vertebral column from the level of the 2-3 th lumbar vertebra and up to the tailbone. The horse tail has 40 roots. Its function is to innervate (nerve supply for communication with the central nervous system) of the pelvic organs and lower limbs.

The cauda equina syndrome is a pathological condition characterized by lesion of roots in the lower part of the spinal canal. This is in most cases due to narrowing (stenosis) of the spinal canal. The reasons for this state can be very diverse:

• degenerative-dystrophic processes in the spine, primarily herniated intervertebral disc (most often there are disc hernias located between the 4th and 5th lumbar vertebrae or between the 5th lumbar and 1st sacral vertebra; the larger the hernia in size, the higher the probability of occurrence of horse tail syndrome);
• Any tumors located in the lower part of the spinal canal, both malignant and benign (this can be tumors of the spinal cord, tumors of its roots, its membranes, as well as metastases of tumors from other organs);
• trauma (fractures, subluxations of vertebrae, gunshot wounds, development of epidural hematomas due to trauma with compression (compression) of the roots of the horse tail);
• infectious diseases (epidural abscess);
• inflammatory diseases (ankylosing spondylitis, Paget's disease);
• congenital anomalies of the spinal canal, accompanied by its narrowing (a decrease in the anteroposterior size of the spinal canal);
• complications from medical manipulations (prolonged spinal anesthesia, poorly fixed metal structures during operations on the spine);
• spondylolisthesis (slipping of one vertebra from another).

Clinical manifestations (symptoms) of the disease

As the pony tail innervates the lower limbs and pelvic organs, respectively, and the symptoms of its defeat will manifest themselves from these structures. Can be observed:

• pain;
• sensitivity disorders;
• muscle weakness;
• impaired bladder function;
• dysfunction of the rectum;
• vegetative-trophic disorders on the lower limbs;
• disorders of sexual function.

Let us consider in more detail each of the symptoms that make up this syndrome.

Pain

Pain can be local and rootlets. Radicular pain often appears first, associated with direct irritation of the roots. They are acute, sometimes shooting through the senses along the course of the nerve roots, that is, the pain itself spreads down one or both legs, gives to the buttocks, perineum, sacrum. Such pains increase with movement and walking. Local pains are felt in the spine, are more dull and chronic. These pains are associated with irritation of soft tissues and structures of the spine. The same patient can have only one type of pain.

Sensitivity disorders

Sensitivity disorders are a feeling of numbness in the region of the sacrum, perineum, buttocks (so called "saddle anesthesia") and in the legs along the root type (in the form of vertical bands from top to bottom). Sensitivity disorders are asymmetrical (mosaic).

Muscle weakness

Muscle weaknessdevelops in the legs, increases with walking. In conjunction with the pain syndrome, this makes the patient sometimes even stop and rest before continuing the movement. Sometimes patients experience difficulties if necessary even standing upright.

Dysfunction of the bladder

Violation of the function of the bladder develops in later terms, rather than pain, sensitivity disorders and muscle weakness, although there are exceptions. Violation of the function of urination can be in the form of difficulty beginning urination, delay urination, lack of a feeling of urge to urinate and a feeling of filling the bladder. When the process stage is started, incontinence can develop.

Dysfunction of the rectum

Violation of the function of the rectum, as well as violations of the bladder, is observed later than the pain in this area. Appear in the form of lack of urge to defecate, violation of gas leakage, constipation, in neglected cases (rarely) - incontinence of feces.

Vegetative-trophic disorders

Vegetative-trophic disorders are much less common. It can be dryness and thinning of the skin on the legs, peeling, sweating, redness or cyanosis of the skin, hair growth disorder.

Disorders of sexual function

Disorders of sexual function are the violation of erection, but rarely the first symptom in the defeat of the horse's tail.

Diagnostics

To establish the diagnosis of horse tail syndrome, the patient collects complaints, anamnesis (history) of the disease, is performed by a neurological examination, revealing an objective decrease in sensitivity, muscle strength, lowering reflexes of the lower limbs. However, this is not enough to reliably confirm the diagnosis due to polymorphism (individual manifestation of the disease in each patient) of the clinical picture of the disease. To additional methods of research, allowing to confirm this diagnosis, include radiography of the lumbosacral department of the spine, computed tomography (CT), magnetic resonance imaging (MRI), myelography. The most informative methods, of course, include conducting MRI (including contrast) and myelography. MRI allows you to obtain a three-dimensional image of the structures of the spine, spinal cord, and, accordingly, and consider the pathological process that led to the development of horse tail syndrome. Myelography is an invasive method of visualization (lumbar puncture is performed with the introduction of contrast medium), which also allows to consider the structures of the spinal canal.

Treatment

Treatment of horse tail syndrome may be conservative or surgical. Of course, the tactics of treatment are chosen only after determining the cause of the disease. If the cause of this disease is acute trauma with compression of the roots in the vertebral canal, then an emergency operative intervention for decompression (reducing the effect of surrounding tissues) compressed roots. The earlier the decompression is carried out in this case, the better the prognosis for the patient, the more quickly the disturbed functions will be restored. Optimal operation is considered in the first 24 hours after the development of an acute condition. Anomalies of the spinal canal, spondylolisthesis in most cases are also treated surgically.

Patients with a disc herniation are also treated surgically (a discectomy or laminectomy is performed). Patients, who caused the syndrome became a tumor, are subject to radiation therapy, chemotherapy and surgical treatment. The combination of these methods, the sequence of their application are determined individually depending on the size, location, nature of the tumor process.

Infectious processes require antibiotic therapy, which is a conservative treatment.

Inflammatory processes (ankylosing spondylitis, Paget's disease) undergo conservative therapy with either non-steroidal anti-inflammatory drugs (NSAIDs), which include diclofenac, ibuprofen, piroxicam, indomethacin, or (in case of ineffectiveness of the latter) corticosteroids (triamcinolone, methylprednisolone, budesonide) or cytostatics (methotrexate). In case of ineffectiveness of conservative treatment, the patient is shown surgical removal of the cause of the syndrome.

The problem of horse tail syndrome is actual for today. Due to the variety of clinical manifestations of this disease, as well as more effective treatment for treatment in the early stages, doctors need to carefully analyze all cases of pain in the back and lower limbs. And patients who have only some of the symptoms described in the article should always seek qualified medical help.

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